Healthcare Provider Details

I. General information

NPI: 1235176702
Provider Name (Legal Business Name): TARZANA EMERGENCY MEDICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 08/04/2022
Certification Date: 08/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18321 CLARK ST
TARZANA CA
91356-3501
US

IV. Provider business mailing address

PO BOX 80676
CITY OF INDUSTRY CA
91716-8414
US

V. Phone/Fax

Practice location:
  • Phone: 310-321-0143
  • Fax: 818-705-2595
Mailing address:
  • Phone: 310-321-0413
  • 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 E EDWARDS
Title or Position: OWNER
Credential:
Phone: 310-321-0143