Healthcare Provider Details

I. General information

NPI: 1467076109
Provider Name (Legal Business Name): MALIBU BEACH HOLDINGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2020
Last Update Date: 05/28/2020
Certification Date: 05/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 34TH ST
BAKERSFIELD CA
93301-2210
US

IV. Provider business mailing address

16885 W BERNARDO DR STE 216
SAN DIEGO CA
92127-1620
US

V. Phone/Fax

Practice location:
  • Phone: 760-331-3177
  • Fax:
Mailing address:
  • Phone: 858-798-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: TOBY TILFORD
Title or Position: CO-CEO
Credential:
Phone: 858-774-8342