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General NPI Number Information
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NPI Number | 1366443103
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Entity Type | Organization
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Legal Business Name | CIROCA CORP.
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Dates
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Enumeration Date | 08/02/2005
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 13624 HAWTHORNE BLVD SUITE 102
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City | HAWTHORNE
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State | CA
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Zip | 90250-5818
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Country | US
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Telephone | 310-679-9844
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Fax | 310-679-7964
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Provider Business Mailing Address
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Address Line | 13624 HAWTHORNE BLVD SUITE 102
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City | HAWTHORNE
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State | CA
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Zip | 90250-5818
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Country | US
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Telephone | 310-679-9844
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Fax | 310-679-7964
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Authorized Official
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Title or Position | VICEPRESIDENT
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Name | MR. JAIRO DE LA ROSA
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Credential |
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Telephone | 310-679-9844
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | PHY46241
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 332BP3500X
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Taxonomy Name | Parenteral & Enteral Nutrition Supplies (DME)
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License Number | PHY46241
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | PHY46241
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number | PHY46241
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License Number State | CA
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