Healthcare Provider Details

I. General information

NPI: 1174413504
Provider Name (Legal Business Name): NAPA PUEBLO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2025
Last Update Date: 11/10/2025
Certification Date: 11/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 PUEBLO AVE
NAPA CA
94558-4751
US

IV. Provider business mailing address

356 S RIMPAU BLVD
LOS ANGELES CA
90020-4828
US

V. Phone/Fax

Practice location:
  • Phone: 323-806-2443
  • Fax:
Mailing address:
  • Phone: 323-806-2443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: M OLIVER ROSENBERG
Title or Position: MANAGER
Credential:
Phone: 562-862-6506