Healthcare Provider Details

I. General information

NPI: 1033098900
Provider Name (Legal Business Name): SAN MARCOS SNF OPERATOR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2025
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1586 W SAN MARCOS BLVD
SAN MARCOS CA
92078-4019
US

IV. Provider business mailing address

6300 WILSHIRE BLVD STE 1800
LOS ANGELES CA
90048-5236
US

V. Phone/Fax

Practice location:
  • Phone: 760-471-2986
  • Fax:
Mailing address:
  • Phone: 323-651-1808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: IRA SMEDRA
Title or Position: MANAGER
Credential:
Phone: 323-651-1808