Healthcare Provider Details

I. General information

NPI: 1295780260
Provider Name (Legal Business Name): JOSEPH S ENGLANOFF M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 07/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21530 PIONEER BLVD
HAWAIIAN GARDENS CA
90716-2608
US

IV. Provider business mailing address

DEPT 2268
LOS ANGELES CA
90084-0001
US

V. Phone/Fax

Practice location:
  • Phone: 714-522-2001
  • Fax: 714-522-7503
Mailing address:
  • Phone: 714-522-2001
  • Fax: 714-522-7503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberG77404
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: