Provider Demographics
NPI:1770801227
Name:CALIFORNIA CARE CORP
Entity type:Organization
Organization Name:CALIFORNIA CARE CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:MING TA
Authorized Official - Last Name:SU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-551-0026
Mailing Address - Street 1:610 N CENTRAL AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-1418
Mailing Address - Country:US
Mailing Address - Phone:818-551-0026
Mailing Address - Fax:818-551-0027
Practice Address - Street 1:610 N CENTRAL AVE STE 106
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-1418
Practice Address - Country:US
Practice Address - Phone:818-551-0026
Practice Address - Fax:818-551-0027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-07
Last Update Date:2010-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA197331305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization