Healthcare Provider Details

I. General information

NPI: 1932954971
Provider Name (Legal Business Name): CA GERIATRIC SPECIALTY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2024
Last Update Date: 06/06/2024
Certification Date: 06/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 W HUFFAKER LN STE 306
RENO NV
89511-2091
US

IV. Provider business mailing address

180 W HUFFAKER LN STE 306
RENO NV
89511-2091
US

V. Phone/Fax

Practice location:
  • Phone: 775-813-7847
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MARIROSE CUTILLAR
Title or Position: OWNER
Credential: MD
Phone: 775-813-7847