Healthcare Provider Details

I. General information

NPI: 1225345614
Provider Name (Legal Business Name): MIRAMONTE ENTERPRISES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2010
Last Update Date: 03/28/2022
Certification Date: 03/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 N SAN JACINTO ST
HEMET CA
92543-4453
US

IV. Provider business mailing address

275 N SAN JACINTO ST
HEMET CA
92543-4453
US

V. Phone/Fax

Practice location:
  • Phone: 951-658-9441
  • Fax:
Mailing address:
  • Phone: 951-658-9441
  • Fax: 951-766-1908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNOT AVAILABLE
License Number StateCA

VIII. Authorized Official

Name: MR. EMMANUEL B. DAVID
Title or Position: MANAGING MEMBER
Credential:
Phone: 310-782-1878