Provider Demographics
NPI:1154520245
Name:MED-I-CAL
Entity type:Organization
Organization Name:MED-I-CAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED NURSE
Authorized Official - Prefix:MS
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GRECO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:760-433-3374
Mailing Address - Street 1:201 COUNTRY CLUB LN
Mailing Address - Street 2:APT 65
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-3425
Mailing Address - Country:US
Mailing Address - Phone:760-433-3374
Mailing Address - Fax:
Practice Address - Street 1:4845 FRAZEE RD
Practice Address - Street 2:APT 701
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92057-6834
Practice Address - Country:US
Practice Address - Phone:760-433-6924
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA505594251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARVN004420OtherPROVIDER NUMBER