Healthcare Provider Details

I. General information

NPI: 1922303718
Provider Name (Legal Business Name): CONQUEST MEDICAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2011
Last Update Date: 09/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2355 FOOTHILL BLVD STE 146
LA VERNE CA
91750-3027
US

IV. Provider business mailing address

9300 SANTA ANITA AVE 103
RANCHO CUCAMONGA CA
91730
US

V. Phone/Fax

Practice location:
  • Phone: 562-805-1876
  • Fax:
Mailing address:
  • Phone: 909-481-8279
  • Fax: 909-980-1378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name: JOE WRIGHT
Title or Position: CEO
Credential:
Phone: 909-481-8279