Provider Demographics
NPI:1023208584
Name:CASA DE SAN BERNARDINO
Entity Type:Organization
Organization Name:CASA DE SAN BERNARDINO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RODOLFO
Authorized Official - Middle Name:L
Authorized Official - Last Name:PINON
Authorized Official - Suffix:III
Authorized Official - Credentials:DIRECTOR
Authorized Official - Phone:909-888-5027
Mailing Address - Street 1:735 N D ST
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92401-1111
Mailing Address - Country:US
Mailing Address - Phone:909-888-5027
Mailing Address - Fax:
Practice Address - Street 1:735 N D ST
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92401-1111
Practice Address - Country:US
Practice Address - Phone:909-888-5027
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-30
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management