Healthcare Provider Details

I. General information

NPI: 1982808416
Provider Name (Legal Business Name): D & U LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 01/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

824 S GLADYS AVE
SAN GABRIEL CA
91776-2710
US

IV. Provider business mailing address

824 S GLADYS AVE
SAN GABRIEL CA
91776-2710
US

V. Phone/Fax

Practice location:
  • Phone: 626-287-0753
  • Fax: 626-286-2421
Mailing address:
  • Phone: 626-287-0753
  • Fax: 626-286-2421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number197603734
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number950000071
License Number StateCA

VIII. Authorized Official

Name: CAROL ELIZABETH DEMARCO
Title or Position: MANAGING MEMBER OF LLC
Credential:
Phone: 626-287-0753