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General NPI Number Information
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NPI Number | 1316724792
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Entity Type | Organization
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Legal Business Name | LA JOLLA CASA FIESTA, LLC
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Dates
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Enumeration Date | 09/11/2023
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Last Update Date | 09/11/2023
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Provider Practice Location Address
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Address Line | 5426 AVENIDA FIESTA
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City | LA JOLLA
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State | CA
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Zip | 92037-7202
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Country | US
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Telephone | 858-245-3766
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Fax | 858-771-1231
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Provider Business Mailing Address
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Address Line | 991 LOMAS SANTA FE DR # C-357
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City | SOLANA BEACH
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State | CA
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Zip | 92075-2141
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Country | US
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Telephone | 858-245-3766
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Fax | 858-771-1231
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Authorized Official
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Title or Position | EMPOYEE
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Name | GUS FERNANDEZ
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Credential |
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Telephone | 858-245-3766
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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