Provider Demographics
NPI:1477002079
Name:ICARE-USA LLC
Entity Type:Organization
Organization Name:ICARE-USA LLC
Other - Org Name:ICARE-USA LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ANECETO
Authorized Official - Middle Name:ALCANTARA
Authorized Official - Last Name:MENDOZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-547-9394
Mailing Address - Street 1:11036 CAMINITO ALVAREZ
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-5701
Mailing Address - Country:US
Mailing Address - Phone:619-547-9394
Mailing Address - Fax:
Practice Address - Street 1:11036 CAMINITO ALVAREZ
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-5701
Practice Address - Country:US
Practice Address - Phone:619-547-9394
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-25
Last Update Date:2016-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA201618710208305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service