Healthcare Provider Details

I. General information

NPI: 1386343705
Provider Name (Legal Business Name): EMMANUEL MENSAH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2023
Last Update Date: 03/29/2024
Certification Date: 03/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2059 HILLMAN ST
TULARE CA
93274-1609
US

IV. Provider business mailing address

2059 HILLMAN ST
TULARE CA
93274-1609
US

V. Phone/Fax

Practice location:
  • Phone: 559-605-0148
  • Fax:
Mailing address:
  • Phone: 732-351-3070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberP120355
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: