Provider Demographics
NPI:1760689731
Name:POMERADO INC
Entity Type:Organization
Organization Name:POMERADO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTS RECEIVABLE SUPERVISOR
Authorized Official - Prefix:MS
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CANDELARIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-446-8754
Mailing Address - Street 1:12696 MONTE VISTA RD
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-2500
Mailing Address - Country:US
Mailing Address - Phone:858-487-6242
Mailing Address - Fax:858-487-4282
Practice Address - Street 1:12696 MONTE VISTA RD
Practice Address - Street 2:
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-2500
Practice Address - Country:US
Practice Address - Phone:858-487-6242
Practice Address - Fax:858-487-4282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-02
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALTC55206HMedicaid
CA555206OtherMEDICARE PROVIDER NUMBER
CA555206Medicare Oscar/Certification
CA555206OtherMEDICARE PROVIDER NUMBER