MEDICARE: EMPOWERED COMMUNITY MANAGEMENT

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	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1922979053
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMPOWERED COMMUNITY MANAGEMENT

Provider Business Mailing Address
First Line	:	3911 CLEVELAND AVE # 33748
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-3402
Country	:	US
Telephone Number	:	805-680-2774
Fax Number	:

Provider Business Practice Location Address
First Line	:	3911 CLEVELAND AVE # 33748
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-3402
Country	:	US
Telephone Number	:	805-386-9712
Fax Number	:

Authorized Official
Title or Position	:	BOARD MEMBER
Name	:	MR. REYNALDO LARA JR.
Credential	:
Telephone Number	:	805-680-2774

Provider Enumeration Date	:	09/12/2025
Last Update Date	:	09/12/2025

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