Provider Demographics
NPI:1801606066
Name:DAVETA, TEMALESI CAGINIVALU
Entity type:Individual
Prefix:
First Name:TEMALESI
Middle Name:CAGINIVALU
Last Name:DAVETA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SUNRISE
Other - Middle Name:RESOURCES
Other - Last Name:LLC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SUNRISE RESOURCES LL
Mailing Address - Street 1:933 EDWARDS AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95401-4239
Mailing Address - Country:US
Mailing Address - Phone:707-239-2400
Mailing Address - Fax:
Practice Address - Street 1:933 EDWARDS AVE APT 2
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-4239
Practice Address - Country:US
Practice Address - Phone:707-239-2400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-09
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7511054388253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD1727157OtherDRIVERS LICENCE