Healthcare Provider Details

I. General information

NPI: 1720239460
Provider Name (Legal Business Name): SAN DIMAS EMERGENCY MEDICAL ASSOCIATES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2008
Last Update Date: 08/04/2022
Certification Date: 08/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 W COVINA BLVD
SAN DIMAS CA
91773-3245
US

IV. Provider business mailing address

PO BOX 80685
CITY OF INDUSTRY CA
91716-8415
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: MR. IRV E. EDWARDS
Title or Position: PRESIDENT
Credential: MD
Phone: 310-321-0143