Healthcare Provider Details

I. General information

NPI: 1487486205
Provider Name (Legal Business Name): DEL CERRO ELDER CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2024
Last Update Date: 08/19/2024
Certification Date: 08/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6288 WENRICH DR
SAN DIEGO CA
92120-3745
US

IV. Provider business mailing address

10441 HUNTERS RIDGE PL
SAN DIEGO CA
92127-4460
US

V. Phone/Fax

Practice location:
  • Phone: 480-286-0552
  • Fax:
Mailing address:
  • Phone: 480-286-0552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: GAURAV RATHI
Title or Position: CEO
Credential:
Phone: 480-286-0552