MEDICARE: MR. JOHN CHARLES DOLCEMASCHIO C.N.A.

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	376K00000X	Nurse's Aide	00537192	CA

General Provider Information

NPI Number	:	1881036234
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN CHARLES DOLCEMASCHIO C.N.A.

Provider Business Mailing Address
First Line	:	1523 E WASHINGTON AVE APT 5
Second Line	:
City	:	EL CAJON
State	:	CA
Zip	:	92019-2554
Country	:	US
Telephone Number	:	619-829-3787
Fax Number	:

Provider Business Practice Location Address
First Line	:	2878 CAMINO DEL RIO S STE 220
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-3845
Country	:	US
Telephone Number	:	619-209-3696
Fax Number	:

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

Provider Enumeration Date	:	07/26/2013
Last Update Date	:	07/26/2013

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