Provider Demographics
NPI:1346723434
Name:MAMA'S KITCHEN
Entity Type:Organization
Organization Name:MAMA'S KITCHEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:CORTES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-233-6262
Mailing Address - Street 1:3960 HOME AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92105-5925
Mailing Address - Country:US
Mailing Address - Phone:619-233-6262
Mailing Address - Fax:
Practice Address - Street 1:3960 HOME AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92105-5925
Practice Address - Country:US
Practice Address - Phone:619-233-6262
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-13
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No332U00000XSuppliersHome Delivered Meals