Healthcare Provider Details

I. General information

NPI: 1710881552
Provider Name (Legal Business Name): SCICOOK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3725 30TH ST
SAN DIEGO CA
92104-3607
US

IV. Provider business mailing address

3725 30TH ST
SAN DIEGO CA
92104-3607
US

V. Phone/Fax

Practice location:
  • Phone: 619-666-5240
  • Fax:
Mailing address:
  • Phone: 619-666-5240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number StateNULL

VIII. Authorized Official

Name: TAHER SATHALIYA
Title or Position: CEO
Credential: PHD
Phone: 619-666-5240