Healthcare Provider Details

I. General information

NPI: 1962143453
Provider Name (Legal Business Name): ALL MED SPECIALIST OF LOS ANGELES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2022
Last Update Date: 02/13/2023
Certification Date: 02/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11001 MAIN ST STE 301
EL MONTE CA
91731-2620
US

IV. Provider business mailing address

PO BOX 2013
BEVERLY HILLS CA
90213-2013
US

V. Phone/Fax

Practice location:
  • Phone: 626-443-4300
  • Fax:
Mailing address:
  • Phone: 213-739-3282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DR. ERNES BONNER
Title or Position: AUTHORIZED OFFICIAL
Credential: MD
Phone: 510-847-1581