Provider Demographics
NPI:1720611502
Name:HOSPICE DE LA FRONTERA
Entity Type:Organization
Organization Name:HOSPICE DE LA FRONTERA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SERGIO
Authorized Official - Middle Name:
Authorized Official - Last Name:CONTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-719-3488
Mailing Address - Street 1:2626 CORONADO AVE SPC 66
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92154-2126
Mailing Address - Country:US
Mailing Address - Phone:619-719-3488
Mailing Address - Fax:
Practice Address - Street 1:2626 CORONADO AVE SPC 66
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92154-2126
Practice Address - Country:US
Practice Address - Phone:619-719-3488
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-19
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF3023165OtherDRIVER LICENSE