Healthcare Provider Details

I. General information

NPI: 1487256400
Provider Name (Legal Business Name): EMPIRE GLOBAL HEALTH GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2020
Last Update Date: 11/13/2020
Certification Date: 11/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1360 VALLEY VISTA DR STE 210
DIAMOND BAR CA
91765-3953
US

IV. Provider business mailing address

1360 VALLEY VISTA DR STE 210
DIAMOND BAR CA
91765-3953
US

V. Phone/Fax

Practice location:
  • Phone: 224-558-9705
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: PEDRO SANQUE
Title or Position: ADMINISTRATOR
Credential:
Phone: 224-558-9705