Healthcare Provider Details

I. General information

NPI: 1790393718
Provider Name (Legal Business Name): ANGELES DEL SOL ADHC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2020
Last Update Date: 07/15/2020
Certification Date: 07/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 N DIAMOND BAR BLVD
DIAMOND BAR CA
91765-1039
US

IV. Provider business mailing address

820 N DIAMOND BAR BLVD
DIAMOND BAR CA
91765-1039
US

V. Phone/Fax

Practice location:
  • Phone: 626-322-2777
  • Fax: 626-788-1352
Mailing address:
  • Phone: 626-322-2777
  • Fax: 626-788-1352

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BOYU LIU
Title or Position: CO-MANAGER
Credential:
Phone: 626-322-2777