Provider Demographics
NPI:1740771435
Name:ICARE CALIFORNIA HOUSE CALL PRACTICE LLC
Entity Type:Organization
Organization Name:ICARE CALIFORNIA HOUSE CALL PRACTICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:CANTON
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:661-303-6888
Mailing Address - Street 1:23000 CRENSHAW BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-3052
Mailing Address - Country:US
Mailing Address - Phone:310-325-4445
Mailing Address - Fax:310-325-4409
Practice Address - Street 1:4460 SPENCER ST
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503
Practice Address - Country:US
Practice Address - Phone:661-303-6888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-29
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP23038363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty