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General NPI Number Information
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NPI Number | 1033098900
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Entity Type | Organization
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Legal Business Name | SAN MARCOS SNF OPERATOR LLC
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Dates
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Enumeration Date | 08/27/2025
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Last Update Date | 08/27/2025
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Provider Practice Location Address
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Address Line | 1586 W SAN MARCOS BLVD
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City | SAN MARCOS
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State | CA
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Zip | 92078-4019
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Country | US
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Telephone | 760-471-2986
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Fax |
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Provider Business Mailing Address
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Address Line | 6300 WILSHIRE BLVD STE 1800
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City | LOS ANGELES
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State | CA
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Zip | 90048-5236
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Country | US
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Telephone | 323-651-1808
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | IRA SMEDRA
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Credential |
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Telephone | 323-651-1808
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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