Healthcare Provider Details

I. General information

NPI: 1487642336
Provider Name (Legal Business Name): DEL RIO SANITARIUM, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 03/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7004 E GAGE AVE
BELL GARDENS CA
90201-2014
US

IV. Provider business mailing address

7004 E GAGE AVE
BELL GARDENS CA
90201-2014
US

V. Phone/Fax

Practice location:
  • Phone: 562-927-6586
  • Fax: 562-928-5097
Mailing address:
  • Phone: 562-927-6586
  • Fax: 562-928-5097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number940000053
License Number StateCA

VIII. Authorized Official

Name: ROBERT VILLALUZ
Title or Position: ADMINISTRATOR
Credential:
Phone: 562-927-6586