Provider Demographics
NPI:1316724792
Name:LA JOLLA CASA FIESTA, LLC
Entity type:Organization
Organization Name:LA JOLLA CASA FIESTA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMPOYEE
Authorized Official - Prefix:
Authorized Official - First Name:GUS
Authorized Official - Middle Name:
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-245-3766
Mailing Address - Street 1:991 LOMAS SANTA FE DR # C-357
Mailing Address - Street 2:
Mailing Address - City:SOLANA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92075-2141
Mailing Address - Country:US
Mailing Address - Phone:858-245-3766
Mailing Address - Fax:858-771-1231
Practice Address - Street 1:5426 AVENIDA FIESTA
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-7202
Practice Address - Country:US
Practice Address - Phone:858-245-3766
Practice Address - Fax:858-771-1231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility