Healthcare Provider Details

I. General information

NPI: 1053523142
Provider Name (Legal Business Name): FIVE ACES HEALTH CARE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 06/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18800 AMAR RD SUITE D-5
WALNUT CA
91789-4166
US

IV. Provider business mailing address

18800 AMAR RD SUITE D-5
WALNUT CA
91789-4166
US

V. Phone/Fax

Practice location:
  • Phone: 626-581-4034
  • Fax: 626-581-1356
Mailing address:
  • Phone: 626-581-4034
  • Fax: 626-581-1356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number060000731
License Number StateCA

VIII. Authorized Official

Name: MR. ALDRIN HALABASO FESTEJO
Title or Position: FISCAL OFFICER
Credential:
Phone: 626-581-4034