=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033413182
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ODOS HOME HEALTH, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/04/2011
-----------------------------------------------------
Last Update Date | 09/02/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7840 EL CAJON BLVD STE 500
-----------------------------------------------------
City | LA MESA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91942-0620
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-362-1637
-----------------------------------------------------
Fax | 858-433-4494
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7840 EL CAJON BLVD STE 500
-----------------------------------------------------
City | LA MESA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91942-0620
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-362-1637
-----------------------------------------------------
Fax | 858-433-4494
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | CEFERINO FAJARDO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 858-362-1637
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------