Healthcare Provider Details

I. General information

NPI: 1861499527
Provider Name (Legal Business Name): EMOONAH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 07/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 S FAIRFAX AVE
LOS ANGELES CA
90019
US

IV. Provider business mailing address

1015 S FAIRFAX AVE
LOS ANGELES CA
90019
US

V. Phone/Fax

Practice location:
  • Phone: 323-939-9490
  • Fax: 323-939-8858
Mailing address:
  • Phone: 323-939-9490
  • Fax: 323-939-8858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number102503
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberPHY48785
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPHY48785
License Number StateCA

VIII. Authorized Official

Name: MR. ROUZBEH JAVAHERIAN
Title or Position: PRESIDENT
Credential:
Phone: 323-939-9490