MEDICARE: KAMELYA HOME HEALTH 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	550003062	OTHER	CA	CA LICENSE

General Provider Information

NPI Number	:	1578986428
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KAMELYA HOME HEALTH INC

Provider Business Mailing Address
First Line	:	438 CAMINO DEL RIO S STE 106
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-3546
Country	:	US
Telephone Number	:	619-303-8341
Fax Number	:	619-303-8806

Provider Business Practice Location Address
First Line	:	438 CAMINO DEL RIO S STE 106
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-3546
Country	:	US
Telephone Number	:	619-303-8341
Fax Number	:	619-303-8806

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. RODEL R AGPAOA
Credential	:
Telephone Number	:	619-303-8341

Provider Enumeration Date	:	01/29/2014
Last Update Date	:	07/29/2021

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