Healthcare Provider Details

I. General information

NPI: 1114362720
Provider Name (Legal Business Name): SAN JOSE ADULT DAY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2013
Last Update Date: 04/11/2022
Certification Date: 04/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7865 SW 24TH ST
MIAMI FL
33155-6522
US

IV. Provider business mailing address

7865 SW 24TH ST
MIAMI FL
33155-6522
US

V. Phone/Fax

Practice location:
  • Phone: 786-768-0184
  • Fax:
Mailing address:
  • Phone: 786-768-0184
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. SERGIO CASARIEGO
Title or Position: OPERATOR
Credential:
Phone: 786-768-0184