Healthcare Provider Details

I. General information

NPI: 1790128114
Provider Name (Legal Business Name): APOLLOMED EMERGENCY MEDICINE MANAGEMENT SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2013
Last Update Date: 04/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9449 SAN FERNANDO RD
SUN VALLEY CA
91352-1421
US

IV. Provider business mailing address

PO BOX 4555
GLENDALE CA
91222-0555
US

V. Phone/Fax

Practice location:
  • Phone: 818-839-5200
  • Fax: 818-839-5190
Mailing address:
  • Phone: 818-839-5200
  • Fax: 818-839-5190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA69768
License Number StateCA

VIII. Authorized Official

Name: KYLE FRANCIS
Title or Position: VP, CHIEF FINANCIAL OFFICER
Credential:
Phone: 818-839-5200