Provider Demographics
NPI:1720636921
Name:CCCRI INC
Entity Type:Organization
Organization Name:CCCRI INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RHEA
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTIZ-LUIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-874-5076
Mailing Address - Street 1:2705 W LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-6325
Mailing Address - Country:US
Mailing Address - Phone:714-874-5076
Mailing Address - Fax:714-876-0705
Practice Address - Street 1:2705 W LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-6325
Practice Address - Country:US
Practice Address - Phone:714-874-5076
Practice Address - Fax:714-876-0705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-30
Last Update Date:2019-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy