Healthcare Provider Details

I. General information

NPI: 1538881487
Provider Name (Legal Business Name): ART OF CARE OUTREACH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2022
Last Update Date: 09/16/2022
Certification Date: 09/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7710 BALBOA AVE STE 329
SAN DIEGO CA
92111-2269
US

IV. Provider business mailing address

7710 BALBOA AVE STE 329
SAN DIEGO CA
92111-2269
US

V. Phone/Fax

Practice location:
  • Phone: 619-642-4284
  • Fax: 619-487-0218
Mailing address:
  • Phone: 619-642-4284
  • Fax: 619-487-0218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code2084H0002X
TaxonomyHospice and Palliative Medicine (Psychiatry & Neurology) Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: LORELIE ANTONIO
Title or Position: ADMINISTRATOR
Credential:
Phone: 619-642-4284