MEDICARE: CIROCA CORP.

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	333600000X	Pharmacy	PHY46241	CA
2	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)	PHY46241	CA
3	332B00000X	Durable Medical Equipment & Medical Supplies	PHY46241	CA
4	332BX2000X	Oxygen Equipment & Supplies (DME)	PHY46241	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0578875	OTHER	CA	NABP
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366443103
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CIROCA CORP.

Provider Business Mailing Address
First Line	:	13624 HAWTHORNE BLVD
Second Line	:	SUITE 102
City	:	HAWTHORNE
State	:	CA
Zip	:	90250-5818
Country	:	US
Telephone Number	:	310-679-9844
Fax Number	:	310-679-7964

Provider Business Practice Location Address
First Line	:	13624 HAWTHORNE BLVD
Second Line	:	SUITE 102
City	:	HAWTHORNE
State	:	CA
Zip	:	90250-5818
Country	:	US
Telephone Number	:	310-679-9844
Fax Number	:	310-679-7964

Authorized Official
Title or Position	:	VICEPRESIDENT
Name	:	MR. JAIRO DE LA ROSA
Credential	:
Telephone Number	:	310-679-9844

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	09/11/2025

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Directions to “CIROCA CORP. ” Practice Location

Language	Start Address	Practice Location

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