Healthcare Provider Details

I. General information

NPI: 1134456296
Provider Name (Legal Business Name): EMINENCE HEALTHCARE MONTEREY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2009
Last Update Date: 11/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 ELKO STREET
GONZALEZ CA
93926
US

IV. Provider business mailing address

114 E SHAW AVE STE 208
FRESNO CA
93710-7621
US

V. Phone/Fax

Practice location:
  • Phone: 559-221-8100
  • Fax: 559-221-8101
Mailing address:
  • Phone: 559-221-8100
  • Fax: 559-221-8101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. CHRISTINE NICOLE HOWLAND
Title or Position: PRESIDENT
Credential: MBA
Phone: 559-221-8100