Healthcare Provider Details

I. General information

NPI: 1689612202
Provider Name (Legal Business Name): SAN GABRIEL MEDICAL INVESTORS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 02/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 W SANTA ANITA AVE
SAN GABRIEL CA
91776-1018
US

IV. Provider business mailing address

3001 KEITH ST NW
CLEVELAND TN
37312-3713
US

V. Phone/Fax

Practice location:
  • Phone: 626-289-5365
  • Fax: 626-289-9503
Mailing address:
  • Phone: 423-473-5751
  • Fax: 423-339-8342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CINDY CROSS
Title or Position: ASSISTANT SECRETARY
Credential:
Phone: 423-473-5867