Healthcare Provider Details

I. General information

NPI: 1285983460
Provider Name (Legal Business Name): SHERMAN OAKS EMERGENCY MEDICAL ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2012
Last Update Date: 09/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4929 VAN NUYS BLVD
SHERMAN OAKS CA
91403-1702
US

IV. Provider business mailing address

PO BOX 660400
ARCADIA CA
91066-0400
US

V. Phone/Fax

Practice location:
  • Phone: 818-907-4570
  • Fax: 818-907-2814
Mailing address:
  • Phone: 626-447-0296
  • Fax: 626-447-6057

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: IRV EDWARDS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 310-379-2134