Provider Demographics
NPI:1164615704
Name:CA RELIABLE MEDICAL SYST INC
Entity Type:Organization
Organization Name:CA RELIABLE MEDICAL SYST INC
Other - Org Name:ELM ADHC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAVERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-333-5383
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:760-653-0015
Practice Address - Street 1:1220 ELM AVE
Practice Address - Street 2:
Practice Address - City:IMPERIAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:91932-2311
Practice Address - Country:US
Practice Address - Phone:619-271-1278
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-27
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA060000581261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAADU70319FOtherMEDI-CAL PROVIDER NUMBER