Healthcare Provider Details

I. General information

NPI: 1992723803
Provider Name (Legal Business Name): EMERGENCY MEDICAL OFFICE INC A PROFESSIONAL MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

264 N HIGHLAND SPRINGS AVE STE 4
BANNING CA
92220-3082
US

IV. Provider business mailing address

264 N HIGHLAND SPRINGS AVE STE 4
BANNING CA
92220-3082
US

V. Phone/Fax

Practice location:
  • Phone: 951-769-0079
  • Fax:
Mailing address:
  • Phone: 951-769-0079
  • Fax: 888-854-7592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: FREDERICK J LLOYD
Title or Position: MEDICAL DOCTOR
Credential: MD
Phone: 951-769-0079