Healthcare Provider Details

I. General information

NPI: 1346258274
Provider Name (Legal Business Name): B-SAN DIEGO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 09/14/2022
Certification Date: 09/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 EUCLID AVE
SAN DIEGO CA
92105-5424
US

IV. Provider business mailing address

1350 EUCLID AVE
SAN DIEGO CA
92105-5424
US

V. Phone/Fax

Practice location:
  • Phone: 619-263-3216
  • Fax: 619-263-5413
Mailing address:
  • Phone: 619-263-3216
  • Fax: 619-263-5413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number090000043
License Number StateCA

VIII. Authorized Official

Name: MR. SHLOMO RECHNITZ
Title or Position: CEO
Credential:
Phone: 626-800-1191