Mary Krystal Home LLC

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

License

374602747 Issued in CA

Legal business name

MARY KRYSTAL HOME LLC

Practice address

2361 Montcliff Rd
San Diego, CA 92139-3914

Phone

(619) 267-3625

NPI assigned

Mar 27, 2017

Last updated

Mar 27, 2017By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Leonora Toledo Pullin, PHARMACY TECHNPI 1881135440

Title

Administrator

Phone

(619) 267-3625

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Leonora Pullin

  • Attendant Care Provider
  • San Diego, CA
  • NPI 1881135440
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1490572800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1490572800000",
    "number": "1891227120",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2361 MONTCLIFF RD",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921393914",
            "telephone_number": "619-267-3625"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2361 MONTCLIFF RD",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921393914",
            "telephone_number": "619-267-3625"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARY KRYSTAL HOME LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-27",
        "last_updated": "2017-03-27",
        "status": "A",
        "authorized_official_last_name": "PULLIN",
        "authorized_official_first_name": "LEONORA",
        "authorized_official_middle_name": "TOLEDO",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "619-267-3625",
        "authorized_official_credential": "PHARMACY TECH"
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "CA",
            "license": "374602747",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "374602747",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Samantha Marx, MD
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• Mary Afzali,DDS, Inc (R.B. Family & Cosmetic Dentistry)
• Mary C Murphy MD
• Mary Jesko & Associates (Jesko & Associates)
• Mary Lou Ham (Angel Wings Express)
• Mary Lydia Engles (Sports Arena Physical Therapy)
• Mary M. O'Connor, DDS, Inc
• Mary McMains OD Med an Optometric Corporation (Insight Vision Development Center, Family Optometry)
• Yolanda Marzan, MD

• Adult Care Home Facility in San Diego, CA
• Providers in San Diego, CA by specialty
• Adult Care Home Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.