Provider Demographics
NPI:1932954971
Name:CA GERIATRIC SPECIALTY CARE
Entity Type:Organization
Organization Name:CA GERIATRIC SPECIALTY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIROSE
Authorized Official - Middle Name:
Authorized Official - Last Name:CUTILLAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:775-813-7847
Mailing Address - Street 1:180 W HUFFAKER LN STE 306
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-2091
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:180 W HUFFAKER LN STE 306
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-2091
Practice Address - Country:US
Practice Address - Phone:775-813-7847
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-23
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty