Healthcare Provider Details

I. General information

NPI: 1063773075
Provider Name (Legal Business Name): SAN GABRIEL HEALTHCARE & WELLNESS CENTRE, LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2012
Last Update Date: 10/19/2022
Certification Date: 10/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 BRIDGE ST
SAN GABRIEL CA
91775-2719
US

IV. Provider business mailing address

115 BRIDGE ST
SAN GABRIEL CA
91775-2719
US

V. Phone/Fax

Practice location:
  • Phone: 626-289-4439
  • Fax: 626-289-0056
Mailing address:
  • Phone: 626-289-4439
  • Fax: 626-289-0056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number950000007
License Number StateCA

VIII. Authorized Official

Name: SHLOMO RECHNITZ
Title or Position: MANAGER
Credential:
Phone: 626-800-1191