Healthcare Provider Details

I. General information

NPI: 1831911528
Provider Name (Legal Business Name): RLSD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2024
Last Update Date: 10/25/2024
Certification Date: 10/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2307 WAILEA WAY
SAN DIEGO CA
92154-1569
US

IV. Provider business mailing address

3724 ALASKA ST
SAN DIEGO CA
92154-2420
US

V. Phone/Fax

Practice location:
  • Phone: 619-600-8462
  • Fax:
Mailing address:
  • Phone: 619-600-8462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. JOSE RAFAEL GONZALES
Title or Position: MANAGER
Credential:
Phone: 619-600-8462