Healthcare Provider Details

I. General information

NPI: 1528348828
Provider Name (Legal Business Name): SAN MARINO GARDENS WELLNESS CENTER, LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2011
Last Update Date: 10/19/2022
Certification Date: 10/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2585 E WASHINGTON BLVD
PASADENA CA
91107-1446
US

IV. Provider business mailing address

2585 E WASHINGTON BLVD
PASADENA CA
91107-1446
US

V. Phone/Fax

Practice location:
  • Phone: 626-463-4105
  • Fax: 626-463-4134
Mailing address:
  • Phone: 626-463-4105
  • Fax: 626-463-4134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number97000008
License Number StateCA

VIII. Authorized Official

Name: SOL MAJER
Title or Position: CEO
Credential:
Phone: 626-800-1191