MEDICARE: HOSPICE DE LA FRONTERA

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	251J00000X	Nursing Care Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	F3023165	OTHER	CA	DRIVER LICENSE

General Provider Information

NPI Number	:	1720611502
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOSPICE DE LA FRONTERA

Provider Business Mailing Address
First Line	:	2626 CORONADO AVE SPC 66
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92154-2126
Country	:	US
Telephone Number	:	619-719-3488
Fax Number	:

Provider Business Practice Location Address
First Line	:	2626 CORONADO AVE SPC 66
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92154-2126
Country	:	US
Telephone Number	:	619-719-3488
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	SERGIO CONTI
Credential	:
Telephone Number	:	619-719-3488

Provider Enumeration Date	:	02/19/2020
Last Update Date	:	02/19/2020

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Directions to “HOSPICE DE LA FRONTERA ” Practice Location

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