Healthcare Provider Details

I. General information

NPI: 1962244681
Provider Name (Legal Business Name): CAAMADI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2024
Last Update Date: 06/12/2024
Certification Date: 06/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RIBERA DEL LAGO 46
JOCOTOPEC JALISCO
45925
MX

IV. Provider business mailing address

500 WESTOVER DR # 19593
SANFORD NC
27330-8941
US

V. Phone/Fax

Practice location:
  • Phone: 888-449-7799
  • Fax:
Mailing address:
  • Phone: 888-444-7799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number State

VIII. Authorized Official

Name: DR. JAVIER EZQUERRA
Title or Position: MGR
Credential: MD
Phone: 888-449-7799