Healthcare Provider Details

I. General information

NPI: 1811081698
Provider Name (Legal Business Name): CASA DE LA FAMILIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 09/18/2023
Certification Date: 09/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 E 4TH ST STE 101
SANTA ANA CA
92701-5159
US

IV. Provider business mailing address

PO BOX 27310
ANAHEIM CA
92809-0110
US

V. Phone/Fax

Practice location:
  • Phone: 877-611-2272
  • Fax: 714-758-1432
Mailing address:
  • Phone: 877-611-2272
  • Fax: 714-758-1432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number48084958
License Number StateCA

VIII. Authorized Official

Name: KARINA PALMA-ROJAS
Title or Position: PROGRAMMATIC DIRECTOR
Credential:
Phone: 877-611-2272