MEDICARE: LA CARLOTAS HOME HEALTH AGENCY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1275307985
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LA CARLOTAS HOME HEALTH AGENCY INC

Provider Business Mailing Address
First Line	:	68 E 11TH ST STE 116
Second Line	:
City	:	TRACY
State	:	CA
Zip	:	95376-4089
Country	:	US
Telephone Number	:	650-653-1608
Fax Number	:

Provider Business Practice Location Address
First Line	:	68 E 11TH ST STE 116
Second Line	:
City	:	TRACY
State	:	CA
Zip	:	95376-4089
Country	:	US
Telephone Number	:	650-653-1608
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	YASHMIN UBALDO
Credential	:
Telephone Number	:	650-653-1608

Provider Enumeration Date	:	11/13/2023
Last Update Date	:	11/13/2023

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Directions to “LA CARLOTAS HOME HEALTH AGENCY INC ” Practice Location

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