Provider Demographics
NPI:1215955182
Name:LEMUEL F & GENA M IGNACIO SUPPORT STAFF SERVICES
Entity type:Organization
Organization Name:LEMUEL F & GENA M IGNACIO SUPPORT STAFF SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LEMUEL
Authorized Official - Middle Name:F
Authorized Official - Last Name:IGNACIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-971-4151
Mailing Address - Street 1:1168 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-2913
Mailing Address - Country:US
Mailing Address - Phone:408-971-4151
Mailing Address - Fax:408-971-3429
Practice Address - Street 1:1168 PARK AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126-2913
Practice Address - Country:US
Practice Address - Phone:408-971-4151
Practice Address - Fax:408-971-3429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA070000304251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHHA57441FMedicaid
CA557441Medicare Oscar/Certification