Provider Demographics
NPI:1346593258
Name:DIMACALI, CLARISSA LAQUI (CNA, HOME HEALTH AID)
Entity Type:Individual
Prefix:MRS
First Name:CLARISSA
Middle Name:LAQUI
Last Name:DIMACALI
Suffix:
Gender:F
Credentials:CNA, HOME HEALTH AID
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 1393
Mailing Address - Street 2:
Mailing Address - City:PACIFICA
Mailing Address - State:CA
Mailing Address - Zip Code:94044
Mailing Address - Country:US
Mailing Address - Phone:650-438-9347
Mailing Address - Fax:
Practice Address - Street 1:50 W. MANOR DR # 1393
Practice Address - Street 2:
Practice Address - City:PACIFICA
Practice Address - State:CA
Practice Address - Zip Code:94044
Practice Address - Country:US
Practice Address - Phone:650-498-7442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-17
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0039232800117875376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide