Provider Demographics
NPI:1730968058
Name:MOMENTRA CARE, INC.
Entity type:Organization
Organization Name:MOMENTRA CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:F
Authorized Official - Last Name:SOTELO
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:619-320-8626
Mailing Address - Street 1:11622 EL CAMINO REAL STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-2051
Mailing Address - Country:US
Mailing Address - Phone:619-320-8626
Mailing Address - Fax:
Practice Address - Street 1:11622 EL CAMINO REAL STE 100
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-2051
Practice Address - Country:US
Practice Address - Phone:619-320-8626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MOMENTRA, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-09-26
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care