Healthcare Provider Details

I. General information

NPI: 1417137597
Provider Name (Legal Business Name): INFINITY CARE OF MAYWOOD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2007
Last Update Date: 04/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6025 PINE AVE
MAYWOOD CA
90270-3108
US

IV. Provider business mailing address

6025 PINE AVE
MAYWOOD CA
90270-3108
US

V. Phone/Fax

Practice location:
  • Phone: 323-560-0720
  • Fax: 323-773-3070
Mailing address:
  • Phone: 323-560-0720
  • Fax: 323-773-3070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number940000116
License Number StateCA

VIII. Authorized Official

Name: DR. MOHAMMAD KAMDAR
Title or Position: VICE PRESIDENT
Credential: M.D.
Phone: 626-334-8265