Provider Demographics
NPI:1053395921
Name:UNICARE CALI HEALTH INC
Entity type:Organization
Organization Name:UNICARE CALI HEALTH INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SECRETARY/PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:GOPAL
Authorized Official - Middle Name:
Authorized Official - Last Name:SOJITRA
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:909-317-3100
Mailing Address - Street 1:930 S MOUNT VERNON AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-3928
Mailing Address - Country:US
Mailing Address - Phone:909-317-3100
Mailing Address - Fax:909-317-3101
Practice Address - Street 1:930 S MOUNT VERNON AVE STE 100
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-3928
Practice Address - Country:US
Practice Address - Phone:909-317-3100
Practice Address - Fax:909-317-3101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-02
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY45319333600000X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA453190Medicaid
0596683OtherNCPDP NUMBER
0596683OtherNCPDP NUMBER