=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528504958
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CATALINA HEALTH CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/09/2017
-----------------------------------------------------
Last Update Date | 04/11/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 183 FAIRWINDS
-----------------------------------------------------
City | COSTA MESA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92626-6586
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-755-5520
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 183 FAIRWINDS
-----------------------------------------------------
City | COSTA MESA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92626-6586
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-755-5520
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | MS. ROSEMARY CASILLAS RODRIGUEZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 714-755-5520
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------