MEDICARE: DANIEL ALDA JR. EXEMPTFROMLICENSURE

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	376J00000X	Homemaker
2	374U00000X	Home Health Aide		CA

General Provider Information

NPI Number	:	1649990300
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL ALDA JR. EXEMPTFROMLICENSURE

Provider Business Mailing Address
First Line	:	11001 BENTON ST
Second Line	:
City	:	LOMA LINDA
State	:	CA
Zip	:	92354-3102
Country	:	US
Telephone Number	:	909-507-1794
Fax Number	:

Provider Business Practice Location Address
First Line	:	11001 BENTON ST
Second Line	:
City	:	LOMA LINDA
State	:	CA
Zip	:	92354-3102
Country	:	US
Telephone Number	:	909-507-1794
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2022
Last Update Date	:	07/11/2024

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