MEDICARE: MARINA VISTA POST ACUTE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	140000139	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	055292	OTHER	CA	MEDICARE OSCAR/CERTIFICATION

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467972430
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARINA VISTA POST ACUTE LLC

Provider Business Mailing Address
First Line	:	107 W LEMON AVE
Second Line	:
City	:	MONROVIA
State	:	CA
Zip	:	91016-2809
Country	:	US
Telephone Number	:	626-346-0300
Fax Number	:	626-737-7260

Provider Business Practice Location Address
First Line	:	1919 CUTTING BLVD
Second Line	:
City	:	RICHMOND
State	:	CA
Zip	:	94804-2662
Country	:	US
Telephone Number	:	510-233-8513
Fax Number	:	510-227-1831

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	CRYSTAL SOLORZANO
Credential	:
Telephone Number	:	626-346-0300

Provider Enumeration Date	:	06/21/2017
Last Update Date	:	06/21/2017

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Directions to “MARINA VISTA POST ACUTE LLC ” Practice Location

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