MEDICARE: EMMANUEL MEDICAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QG0300X	Geriatric Medicine (Family Medicine) Physician		CA

General Provider Information

NPI Number	:	1518043264
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMMANUEL MEDICAL CORPORATION

Provider Business Mailing Address
First Line	:	1817 W BEVERLY BLVD
Second Line	:
City	:	MONTEBELLO
State	:	CA
Zip	:	90640-3969
Country	:	US
Telephone Number	:	323-721-5524
Fax Number	:	323-837-1465

Provider Business Practice Location Address
First Line	:	1817 W BEVERLY BLVD
Second Line	:
City	:	MONTEBELLO
State	:	CA
Zip	:	90640-3935
Country	:	US
Telephone Number	:	323-721-5524
Fax Number	:	323-837-1465

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. GABRIELA HERNANDEZ
Credential	:	RN
Telephone Number	:	951-310-2488

Provider Enumeration Date	:	10/27/2006
Last Update Date	:	03/10/2026

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Directions to “EMMANUEL MEDICAL CORPORATION ” Practice Location

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