Provider Demographics
NPI:1265657209
Name:DEL MONTE ICF INC
Entity Type:Organization
Organization Name:DEL MONTE ICF INC
Other - Org Name:DEL MONTE ICF DDN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSEMARIE
Authorized Official - Middle Name:TAMBOT
Authorized Official - Last Name:VERIDIANO
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:650-580-2983
Mailing Address - Street 1:210 DEL MONTE AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-2220
Mailing Address - Country:US
Mailing Address - Phone:650-876-0549
Mailing Address - Fax:
Practice Address - Street 1:2893 EL CAMINO REAL
Practice Address - Street 2:SUITE C
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94061-4001
Practice Address - Country:US
Practice Address - Phone:650-216-9960
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA55G095OtherLONG TERM CARE