Healthcare Provider Details

I. General information

NPI: 1518904150
Provider Name (Legal Business Name): SHERMAN OAKS EMERGENCY MEDICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 07/21/2022
Certification Date: 05/02/2022
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 80616
CITY OF INDUSTRY CA
91716-8411
US

V. Phone/Fax

Practice location:
  • Phone: 310-379-2134
  • Fax: 310-379-4856
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 StateCA

VIII. Authorized Official

Name: IRV EDWARDS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 310-321-0143