Del Rosa Villa, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

240000029 Issued in CA

Legal business name

DEL ROSA VILLA, LLC

Practice address

2018 Del Rosa Ave
San Bernardino, CA 92404-5642

Phone

(909) 885-3261

Fax

(909) 888-3871

NPI assigned

Aug 3, 2005

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Elizabeth Plott Tyler, J.D

Title

Vice President of Operations

Phone

(323) 655-6960

Specialties & licenses 2

Addresses

Other identifiers 2

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1123027200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1425513600000",
    "number": "1235130915",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5455 WILSHIRE BLVD",
            "address_2": "SUITE 1925",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900364201",
            "telephone_number": "323-655-6960",
            "fax_number": "323-655-7122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2018 DEL ROSA AVE",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924045642",
            "telephone_number": "909-885-3261",
            "fax_number": "909-888-3871"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEL ROSA VILLA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-03",
        "last_updated": "2015-03-05",
        "status": "A",
        "authorized_official_last_name": "TYLER",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_middle_name": "PLOTT",
        "authorized_official_title_or_position": "VICE PRESIDENT OF OPERATIONS",
        "authorized_official_telephone_number": "323-655-6960",
        "authorized_official_credential": "J.D"
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "CA",
            "license": "240000029",
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CA",
            "license": "240000029",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID-TYPE UNSPECIFIED",
            "identifier": "55-5195",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "LTC90017G",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cathleen Deharo-Schisler
• Christine Elizabeth Deibler
• Ana Magdalena Del Nogal
• Angeline Del Puerto
• Julieta Del Rio
• Del Rosa Villaidence Opco, LLC
• Leslie Del Toro
• Gabriella Raen Sabio Del Vecchio
• Joanna Luna Dela Cruz, RN
• Nicole Dela Cruz

• Skilled Nursing Facility in San Bernardino, CA
• Providers in San Bernardino, CA by specialty
• Skilled Nursing Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.