Healthcare Provider Details

I. General information

NPI: 1194067272
Provider Name (Legal Business Name): CDM HEALTH CARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2013
Last Update Date: 03/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3665 RUFFIN RD SUITE 100
SAN DIEGO CA
92123-1855
US

IV. Provider business mailing address

3665 RUFFIN RD SUITE 100
SAN DIEGO CA
92123-1855
US

V. Phone/Fax

Practice location:
  • Phone: 619-757-1114
  • Fax: 619-448-8078
Mailing address:
  • Phone: 619-757-1114
  • Fax: 619-448-8078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. CHARLES WILLIAM MATHIS III
Title or Position: PRESIDENT
Credential:
Phone: 619-757-1114