=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205279148
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LA CASA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/10/2013
-----------------------------------------------------
Last Update Date | 04/10/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 909 BLANCO CIRCLE
-----------------------------------------------------
City | SALINAS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93901
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-318-7637
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 909 BLANCO CIR
-----------------------------------------------------
City | SALINAS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93901-4401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-318-7637
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | RAKESH CHAND
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 408-318-7637
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 302R00000X
-----------------------------------------------------
Taxonomy Name | Health Maintenance Organization
-----------------------------------------------------
License Number | 550001526
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------