Provider Demographics
NPI:1902471667
Name:NATALIE AND DESTINY ENTERPRISES LLC
Entity Type:Organization
Organization Name:NATALIE AND DESTINY ENTERPRISES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MORENO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-429-8665
Mailing Address - Street 1:42 W CAMPBELL AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-1042
Mailing Address - Country:US
Mailing Address - Phone:408-429-8665
Mailing Address - Fax:408-540-7263
Practice Address - Street 1:42 W CAMPBELL AVE STE 101
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-1042
Practice Address - Country:US
Practice Address - Phone:408-429-8665
Practice Address - Fax:408-540-7263
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NATALIE AND DESTINY ENTERPRISES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-05-25
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health