Provider Demographics
NPI:1669236816
Name:DSP CCA, INC.
Entity type:Organization
Organization Name:DSP CCA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MARICON
Authorized Official - Middle Name:PADUA
Authorized Official - Last Name:PARDUCHO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-587-0028
Mailing Address - Street 1:1815 E WORKMAN AVE STE D1
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91791-1423
Mailing Address - Country:US
Mailing Address - Phone:626-587-0028
Mailing Address - Fax:626-587-0031
Practice Address - Street 1:1815 E WORKMAN AVE STE D1
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91791-1423
Practice Address - Country:US
Practice Address - Phone:626-587-0028
Practice Address - Fax:626-587-0031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-08
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management