Healthcare Provider Details

I. General information

NPI: 1821320417
Provider Name (Legal Business Name): SAN PABLO HEALTHCARE & WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2010
Last Update Date: 10/19/2022
Certification Date: 10/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13328 SAN PABLO AVE
SAN PABLO CA
94806-3902
US

IV. Provider business mailing address

13328 SAN PABLO AVE
SAN PABLO CA
94806-3902
US

V. Phone/Fax

Practice location:
  • Phone: 510-235-3720
  • Fax: 510-235-0789
Mailing address:
  • Phone: 510-235-3720
  • Fax: 510-235-0789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number140000079
License Number StateCA

VIII. Authorized Official

Name: MR. SOL MAJER
Title or Position: PRESIDENT
Credential:
Phone: 626-800-1191