Healthcare Provider Details

I. General information

NPI: 1427735265
Provider Name (Legal Business Name): ELDERS ANGEL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2023
Last Update Date: 11/10/2023
Certification Date: 11/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8525 GIBBS DR STE 304
SAN DIEGO CA
92123-1700
US

IV. Provider business mailing address

8525 GIBBS DR STE 304
SAN DIEGO CA
92123-1700
US

V. Phone/Fax

Practice location:
  • Phone: 858-868-1577
  • Fax:
Mailing address:
  • Phone: 858-868-1577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. MADALINA IOANA RUSOIU
Title or Position: CEO
Credential:
Phone: 858-868-1577