Healthcare Provider Details

I. General information

NPI: 1891410833
Provider Name (Legal Business Name): SVPA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2022
Last Update Date: 09/05/2025
Certification Date: 09/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6812 OAK AVE
SAN GABRIEL CA
91775-2030
US

IV. Provider business mailing address

4016 GRAND AVE STE A-1060
CHINO CA
91710-5491
US

V. Phone/Fax

Practice location:
  • Phone: 626-446-5263
  • Fax: 626-910-0005
Mailing address:
  • Phone: 626-523-8956
  • Fax: 626-657-2778

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: CAROLINE TAPANG DITULLIO
Title or Position: CO MANAGER
Credential:
Phone: 626-523-8956