Provider Demographics
NPI:1114411386
Name:NEW ENTRA CASA CORPORATION
Entity Type:Organization
Organization Name:NEW ENTRA CASA CORPORATION
Other - Org Name:NEW ENTRA CASA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:DUIN
Authorized Official - Suffix:
Authorized Official - Credentials:SUDCC
Authorized Official - Phone:619-294-4526
Mailing Address - Street 1:3575 PERSHING AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92104-3413
Mailing Address - Country:US
Mailing Address - Phone:619-294-4526
Mailing Address - Fax:619-294-4526
Practice Address - Street 1:3575 PERSHING AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92104-3413
Practice Address - Country:US
Practice Address - Phone:619-294-4526
Practice Address - Fax:619-294-4526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-20
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA370083AN261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center