=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043984321
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DENPTAAJ LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/02/2021
-----------------------------------------------------
Last Update Date | 03/09/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2531 OLIVE DR STE E
-----------------------------------------------------
City | PALMDALE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93550-1036
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 424-625-1447
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 38035 53RD ST E
-----------------------------------------------------
City | PALMDALE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93552-3224
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 424-625-1447
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | ESTHER OTITEH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 424-625-1447
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------