Healthcare Provider Details

I. General information

NPI: 1760685671
Provider Name (Legal Business Name): ST. BARNABAS SENIOR CENTER OF LOS ANGELES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2007
Last Update Date: 07/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 SOUTH CARONDELET STREET
LOS ANGELES CA
90057-3309
US

IV. Provider business mailing address

675 SOUTH CARONDELET STREET
LOS ANGELES CA
90057-3309
US

V. Phone/Fax

Practice location:
  • Phone: 213-388-4444
  • Fax: 213-739-2972
Mailing address:
  • Phone: 213-388-4444
  • Fax: 213-739-2972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number060000600
License Number StateCA

VIII. Authorized Official

Name: RIGO J. SABORIO
Title or Position: PRESIDENT/CEO
Credential: MSG
Phone: 213-388-4444