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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