Healthcare Provider Details

I. General information

NPI: 1639791429
Provider Name (Legal Business Name): SALIDA DEL SOL CBAS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2020
Last Update Date: 05/14/2020
Certification Date: 05/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5350 ATLANTIC AVE
LONG BEACH CA
90805-6020
US

IV. Provider business mailing address

5350 ATLANTIC AVE
LONG BEACH CA
90805-6020
US

V. Phone/Fax

Practice location:
  • Phone: 619-764-1569
  • Fax:
Mailing address:
  • Phone: 619-764-1569
  • Fax:

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: PRESIDENT
Credential:
Phone: 619-764-1569