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Organization
CIROCA CORP.
Active
Organization
CIROCA CORP.
Active
Other names
Supermarket Pharmacy and Health Care Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAIRO DE LA ROSA (VICEPRESIDENT)
(310) 679-9844
Entity
Organization
Contact information
Practice address
13624 HAWTHORNE BLVD, SUITE 102, HAWTHORNE, CA 90250-5818
(310) 679-9844
(310) 679-7964
Mailing address
13624 HAWTHORNE BLVD, SUITE 102, HAWTHORNE, CA 90250-5818
(310) 679-9844
(310) 679-7964
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
PHY46241
CA
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
PHY46241
CA
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
PHY46241
CA
333600000X
Pharmacy
PHY46241
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0578875
NABP
CA
05
—
PHA462410
—
CA
Enumeration date
08/02/2005
Last updated
09/11/2025
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