Healthcare Provider Details

I. General information

NPI: 1417860867
Provider Name (Legal Business Name): AEA ENTERPRISES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 S 1ST ST STE 219
SAN JOSE CA
95113-2835
US

IV. Provider business mailing address

325 S 1ST ST STE 219
SAN JOSE CA
95113-2835
US

V. Phone/Fax

Practice location:
  • Phone: 408-684-5364
  • Fax: 408-882-6227
Mailing address:
  • Phone: 408-684-5364
  • Fax: 408-882-6227

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: MR. CARLITO DAGUMAN AMISTOSO
Title or Position: ADMINISTRATOR/OWNER
Credential:
Phone: 805-470-2714