Provider Demographics
NPI:1093227738
Name:THE HOSPICE OF SAN DIEGO
Entity Type:Organization
Organization Name:THE HOSPICE OF SAN DIEGO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/DPCS
Authorized Official - Prefix:MS
Authorized Official - First Name:MYRNA
Authorized Official - Middle Name:MITERIA
Authorized Official - Last Name:RODILLON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:858-699-3445
Mailing Address - Street 1:12616 SORA WAY
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-4145
Mailing Address - Country:US
Mailing Address - Phone:858-699-3445
Mailing Address - Fax:858-538-6412
Practice Address - Street 1:12616 SORA WAY
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92129-4145
Practice Address - Country:US
Practice Address - Phone:858-699-3445
Practice Address - Fax:858-538-6412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-03
Last Update Date:2017-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based