# POMERADO INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1760689731
- **Authorized official:** MS. VALERIE CANDELARIA (ACCOUNTS RECEIVABLE SUPERVISOR)
- **Authorized official phone:** (909) 446-8754

## Contact information

- **Practice address:** 12696 MONTE VISTA RD, POWAY, CA 92064-2500
- **Practice address phone:** (858) 487-6242
- **Practice address fax:** (858) 487-4282
- **Mailing address:** 12696 MONTE VISTA RD, POWAY, CA 92064-2500
- **Mailing address phone:** (858) 487-6242
- **Mailing address fax:** (858) 487-4282

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | — | CA | Yes |

## Other

- **Enumeration date:** 07/02/2007
- **Last updated:** 07/16/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 555206 | MEDICARE PROVIDER NUMBER | CA |
| 05 | — | LTC55206H | — | CA |