MEDICARE: SKYCARE CUIDADO DEL CIELO LLC

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	101Y00000X	Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	96139	OTHER		STATE OF CALIFORNIA

General Provider Information

NPI Number	:	1689271454
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SKYCARE CUIDADO DEL CIELO LLC

Provider Business Mailing Address
First Line	:	7890 E SPRING ST UNIT 10D
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90815-1622
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7890 E SPRING ST UNIT 10D
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90815-1622
Country	:	US
Telephone Number	:	714-605-9421
Fax Number	:

Authorized Official
Title or Position	:	PEESIDENT
Name	:	VANESSA PONS
Credential	:
Telephone Number	:	714-605-9421

Provider Enumeration Date	:	10/05/2020
Last Update Date	:	10/05/2020

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