Healthcare Provider Details

I. General information

NPI: 1669507620
Provider Name (Legal Business Name): EMANATE HEALTH MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 10/27/2020
Certification Date: 10/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 W SAN BERNARDINO RD
COVINA CA
91723-1515
US

IV. Provider business mailing address

210 W SAN BERNARDINO RD P.O. BOX 6108
COVINA CA
91723-1515
US

V. Phone/Fax

Practice location:
  • Phone: 626-915-6273
  • Fax: 626-859-5887
Mailing address:
  • Phone: 626-915-6273
  • Fax: 626-859-5887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License NumberHSP43961
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: ROGER SHARMA
Title or Position: EXECUTIVE VP/CFO
Credential:
Phone: 626-938-7595