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General NPI Number Information
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NPI Number | 1346593258
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Entity Type | Individual
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Provider Name | CLARISSA LAQUI DIMACALI CNA, HOME HEALTH AID
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Gender | Female
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Dates
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Enumeration Date | 10/17/2012
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Last Update Date | 10/17/2012
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Provider Practice Location Address
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Address Line | 50 W. MANOR DR # 1393
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City | PACIFICA
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State | CA
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Zip | 94044
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Country | US
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Telephone | 650-498-7442
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Fax |
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Provider Business Mailing Address
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Address Line | P.O. BOX 1393
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City | PACIFICA
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State | CA
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Zip | 94044
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Country | US
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Telephone | 650-438-9347
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number | 0039232800117875
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License Number State | CA
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