Healthcare Provider Details

I. General information

NPI: 1871457952
Provider Name (Legal Business Name): COLLEGE NANNIES AND TUTORS OF SOCAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2025
Last Update Date: 12/12/2025
Certification Date: 12/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 W B ST FL 4
SAN DIEGO CA
92101-3537
US

IV. Provider business mailing address

2400 W LAKE OF THE ISLES PKWY
MINNEAPOLIS MN
55405-2331
US

V. Phone/Fax

Practice location:
  • Phone: 952-698-2011
  • Fax:
Mailing address:
  • Phone: 952-698-2011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: ERIC ROBERTS
Title or Position: OWNER
Credential:
Phone: 952-698-2011