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General NPI Number Information
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NPI Number | 1912371816
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Entity Type | Organization
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Legal Business Name | CASA CERRITOS, LLC
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Dates
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Enumeration Date | 11/16/2015
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Last Update Date | 11/17/2015
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Provider Practice Location Address
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Address Line | 10802 ANDY ST
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City | CERRITOS
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State | CA
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Zip | 90703-8064
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Country | US
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Telephone | 562-225-2649
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Fax |
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Provider Business Mailing Address
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Address Line | 10802 ANDY ST
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City | CERRITOS
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State | CA
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Zip | 90703-8064
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Country | US
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Telephone | 562-225-2649
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | TERESA SIATON MENDOZA
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Credential | NP
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Telephone | 562-225-2649
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 198602141
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License Number State | CA
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