Healthcare Provider Details

I. General information

NPI: 1023699410
Provider Name (Legal Business Name): DM SINALOA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2021
Last Update Date: 04/16/2021
Certification Date: 04/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1432 SINALOA RD
SIMI VALLEY CA
93065-3031
US

IV. Provider business mailing address

150 N SANTA ANITA AVE STE 300
ARCADIA CA
91006-3116
US

V. Phone/Fax

Practice location:
  • Phone: 805-285-0022
  • Fax:
Mailing address:
  • Phone: 626-375-8888
  • 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: MICHAEL HSU
Title or Position: MANAGER
Credential:
Phone: 626-375-8888