Provider Demographics
NPI:1194062976
Name:SAN DIEGO MEDICAL STAFFING & HOME HEALTHCARE SERVICES, LLC
Entity type:Organization
Organization Name:SAN DIEGO MEDICAL STAFFING & HOME HEALTHCARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN SALVADOR
Authorized Official - Middle Name:CASAS
Authorized Official - Last Name:LACABA
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:760-889-1301
Mailing Address - Street 1:PO BOX 1822
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92018-1822
Mailing Address - Country:US
Mailing Address - Phone:760-889-1301
Mailing Address - Fax:760-994-1263
Practice Address - Street 1:3753 MISSION AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92058-1471
Practice Address - Country:US
Practice Address - Phone:760-529-5871
Practice Address - Fax:760-994-1263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-14
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CABL122084251E00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health