=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649376773
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEALTH DESTINATIONS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/16/2006
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3410 N SAN FERNANDO RD STE 2
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90065-1442
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-257-5848
-----------------------------------------------------
Fax | 323-257-5848
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3410 N SAN FERNANDO RD STE 2
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90065-1442
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-257-5848
-----------------------------------------------------
Fax | 323-257-5848
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF PATIENT CARE SERVICES
-----------------------------------------------------
Name | CLEVELAND S ESTRELLA
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 323-257-5848
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 251E00000X-HOME HEAL
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------