Provider Demographics
NPI:1013795020
Name:SALIDA DEL SOL CBAS, LLC
Entity Type:Organization
Organization Name:SALIDA DEL SOL CBAS, LLC
Other - Org Name:SALIDA DEL SOL ECM
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BOYU
Authorized Official - Middle Name:
Authorized Official - Last Name:LIU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-561-0999
Mailing Address - Street 1:5350 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90805-6020
Mailing Address - Country:US
Mailing Address - Phone:562-269-4355
Mailing Address - Fax:
Practice Address - Street 1:5350 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90805-6020
Practice Address - Country:US
Practice Address - Phone:562-269-4355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SALIDA DEL SOL CBAS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-09-20
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health