Provider Demographics
NPI:1700404852
Name:ENVISAGE PALLIATIVE CARE
Entity Type:Organization
Organization Name:ENVISAGE PALLIATIVE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DON ARTHUR
Authorized Official - Middle Name:
Authorized Official - Last Name:ESTUITA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-699-4388
Mailing Address - Street 1:11428 ARTESIA BLVD STE 5A
Mailing Address - Street 2:
Mailing Address - City:ARTESIA
Mailing Address - State:CA
Mailing Address - Zip Code:90701-3800
Mailing Address - Country:US
Mailing Address - Phone:562-330-1241
Mailing Address - Fax:562-800-7662
Practice Address - Street 1:7369 SOLSTICE PL
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91739-8769
Practice Address - Country:US
Practice Address - Phone:818-699-4388
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-06
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative MedicineGroup - Single Specialty