Provider Demographics
NPI:1093921900
Name:CA RELIABLE MEDICAL SYSTEMS, INC,
Entity Type:Organization
Organization Name:CA RELIABLE MEDICAL SYSTEMS, INC,
Other - Org Name:GOLDEN LIFE ADHC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SRAGOVICZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-779-4826
Mailing Address - Street 1:11110 RED CEDAR DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-1310
Mailing Address - Country:US
Mailing Address - Phone:858-776-1468
Mailing Address - Fax:
Practice Address - Street 1:11110 RED CEDAR DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131-1310
Practice Address - Country:US
Practice Address - Phone:858-776-1468
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0600921261QA0600X
CA060000581261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAADU70319FMedicaid
CAADU70407FMedicaid