Healthcare Provider Details

I. General information

NPI: 1588198055
Provider Name (Legal Business Name): EAST LA EMERGENCY PHYSICIANS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2017
Last Update Date: 08/04/2022
Certification Date: 08/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4060 WHITTIER BLVD
LOS ANGELES CA
90023-2526
US

IV. Provider business mailing address

PO BOX 80070
CITY OF INDUSTRY CA
91716-8070
US

V. Phone/Fax

Practice location:
  • Phone: 310-321-0143
  • Fax:
Mailing address:
  • Phone: 310-321-0143
  • Fax: 310-379-4856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES DE LA TORRE
Title or Position: PRESIDENT
Credential: MD
Phone: 310-321-0143