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General NPI Number Information
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NPI Number | 1376116210
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Entity Type | Organization
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Legal Business Name | AGE CONNECTION CCA, LLC
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Dates
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Enumeration Date | 07/19/2021
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Last Update Date | 07/19/2021
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Provider Practice Location Address
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Address Line | 2835 PENASCO
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City | SAN CLEMENTE
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State | CA
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Zip | 92673-3559
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Country | US
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Telephone | 949-492-1253
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Fax |
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Provider Business Mailing Address
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Address Line | 2835 PENASCO
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City | SAN CLEMENTE
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State | CA
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Zip | 92673-3559
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Country | US
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Telephone | 949-492-1253
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MILAGROS ASEJO EPHRAIM
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Credential |
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Telephone | 949-326-3665
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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