Healthcare Provider Details

I. General information

NPI: 1730414681
Provider Name (Legal Business Name): UMANA CARE LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2009
Last Update Date: 12/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 N BUSH ST 101
SANTA ANA CA
92706-2852
US

IV. Provider business mailing address

1800 N BUSH ST 101
SANTA ANA CA
92706-2852
US

V. Phone/Fax

Practice location:
  • Phone: 714-568-0048
  • Fax: 714-922-6038
Mailing address:
  • Phone: 714-568-0048
  • Fax: 714-922-6038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number550001532
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number05D2017678
License Number StateCA

VIII. Authorized Official

Name: EHKY GUTIERREZ
Title or Position: MEMBER
Credential: ED
Phone: 714-673-9208