Healthcare Provider Details

I. General information

NPI: 1649045733
Provider Name (Legal Business Name): FIJI PRIME IN-HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2023
Last Update Date: 11/17/2023
Certification Date: 11/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 FARMERS LN STE 6
SANTA ROSA CA
95405-6742
US

IV. Provider business mailing address

725 FARMERS LN STE 6
SANTA ROSA CA
95405-6742
US

V. Phone/Fax

Practice location:
  • Phone: 707-889-9505
  • Fax: 707-852-2113
Mailing address:
  • Phone: 707-889-9505
  • 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: MS. TITILIA LEDUA
Title or Position: OWNER
Credential:
Phone: 707-889-9505