Provider Demographics
NPI:1356528640
Name:RBB HEALTHCARE INC.
Entity type:Organization
Organization Name:RBB HEALTHCARE INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARINO
Authorized Official - Middle Name:
Authorized Official - Last Name:DEPAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-963-5955
Mailing Address - Street 1:435 E GLADSTONE ST
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-5159
Mailing Address - Country:US
Mailing Address - Phone:626-963-5955
Mailing Address - Fax:626-963-5235
Practice Address - Street 1:435 E GLADSTONE ST
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-5159
Practice Address - Country:US
Practice Address - Phone:626-963-5955
Practice Address - Fax:626-963-5235
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RBB HEALTHCARE INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-29
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALTC70155FMedicaid