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NPI Code Detail

MEDICARE: SAN GABRIEL VALLEY CONVALESCENT HOSPITAL, INC.

MEDICARE: SAN GABRIEL VALLEY CONVALESCENT HOSPITAL, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing Facility05A360CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1891781423
Entity Type Code : Organization
Provider Name (Legal Business Name) : SAN GABRIEL VALLEY CONVALESCENT HOSPITAL, INC.
Provider Business Mailing Address
First Line : 3938 COGSWELL RD
Second Line :
City : EL MONTE
State : CA
Zip : 91732-2404
Country : US
Telephone Number : 626-401-1557
Fax Number :
Provider Business Practice Location Address
First Line : 3938 COGSWELL RD
Second Line :
City : EL MONTE
State : CA
Zip : 91732-2404
Country : US
Telephone Number : 626-401-1557
Fax Number :
Authorized Official
Title or Position : ADMINISTRATOR
Name : DORI DIMLA
Credential :
Telephone Number : 626-401-1557
Provider Enumeration Date : 09/20/2005
Last Update Date : 08/22/2020

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