Provider Demographics
NPI:1407376007
Name:NEIGHBORHOOD HOUSE CALL DOCTOR, INC
Entity Type:Organization
Organization Name:NEIGHBORHOOD HOUSE CALL DOCTOR, INC
Other - Org Name:N/A
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER/SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:IBARRA
Authorized Official - Middle Name:G
Authorized Official - Last Name:DIANGKINAY
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:956-240-4339
Mailing Address - Street 1:26960 CHERRY HILLS BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:SUN CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92586-2512
Mailing Address - Country:US
Mailing Address - Phone:956-240-4339
Mailing Address - Fax:
Practice Address - Street 1:26960 CHERRY HILLS BLVD STE A
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:CA
Practice Address - Zip Code:92586-2512
Practice Address - Country:US
Practice Address - Phone:956-240-4339
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95004040363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty