Healthcare Provider Details

I. General information

NPI: 1962331918
Provider Name (Legal Business Name): COMPLETE CARE PACE PROGRAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6609 VAN NUYS BLVD # 102
VAN NUYS CA
91405-4618
US

IV. Provider business mailing address

6609 VAN NUYS BLVD STE 201-A
VAN NUYS CA
91405-4618
US

V. Phone/Fax

Practice location:
  • Phone: 888-605-0108
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251T00000X
TaxonomyPACE Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: MARISOL RAMIREZ
Title or Position: CAO
Credential:
Phone: 818-812-5410