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General NPI Number Information
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NPI Number | 1376199422
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Entity Type | Organization
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Legal Business Name | PICO DE LORO, INCORPORATED
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Dates
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Enumeration Date | 08/14/2019
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Last Update Date | 08/14/2019
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Provider Practice Location Address
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Address Line | 620 NORTH PERRIS BOULEVARD
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City | PERRIS
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State | CA
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Zip | 92571
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Country | US
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Telephone | 951-943-8081
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Fax | 951-943-8044
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Provider Business Mailing Address
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Address Line | 16807 NANDINA AVENUE
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City | RIVERSIDE
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State | CA
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Zip | 92504-8703
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Country | US
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Telephone | 951-675-7633
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Fax | 951-943-8044
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Authorized Official
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Title or Position | VICE-PRESIDENT
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Name | MRS. VIVIEN FABELLO RILLO
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Credential |
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Telephone | 951-675-7633
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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