Healthcare Provider Details

I. General information

NPI: 1437493970
Provider Name (Legal Business Name): EQUALITY, AN INDEPENDENT PRACTICE ASSOCIATION, INC., A MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2012
Last Update Date: 11/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2360 HUNTINGTON DR STE 201 SAN MARINO
SAN MARINO CA
91108-2651
US

IV. Provider business mailing address

2360 HUNTINGTON DR STE 201 SAN MARINO
SAN MARINO CA
91108-2651
US

V. Phone/Fax

Practice location:
  • Phone: 818-399-8996
  • Fax:
Mailing address:
  • Phone: 818-399-8996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: MS. LAN NHU BICH PHAN
Title or Position: ADMINISTRATOR
Credential:
Phone: 818-399-8996