Healthcare Provider Details

I. General information

NPI: 1639166242
Provider Name (Legal Business Name): 533 SOUTH FAIRFAX AVENUE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 12/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

533 S FAIRFAX AVE
LOS ANGELES CA
90036-3129
US

IV. Provider business mailing address

4115 E BROADWAY
LONG BEACH CA
90803-1532
US

V. Phone/Fax

Practice location:
  • Phone: 323-931-1061
  • Fax: 323-931-1943
Mailing address:
  • Phone: 562-930-0777
  • Fax: 562-930-0728

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number910000146
License Number StateCA

VIII. Authorized Official

Name: ROSALIE PIACENTI SANCHEZ
Title or Position: MANAGER
Credential:
Phone: 562-930-0777