Provider Demographics
NPI:1740905793
Name:CVPAC LLC
Entity type:Organization
Organization Name:CVPAC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:TAPANG
Authorized Official - Last Name:DITULLIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-523-8956
Mailing Address - Street 1:4016 GRAND AVE STE A-1064
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-5491
Mailing Address - Country:US
Mailing Address - Phone:626-523-8956
Mailing Address - Fax:626-657-2778
Practice Address - Street 1:20554 ROSCOE BLVD
Practice Address - Street 2:
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91306-1746
Practice Address - Country:US
Practice Address - Phone:818-341-9800
Practice Address - Fax:818-533-6785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-11
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility