Healthcare Provider Details

I. General information

NPI: 1184309411
Provider Name (Legal Business Name): SENIOR HEALTH ASSOCIATES A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2023
Last Update Date: 06/15/2023
Certification Date: 06/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

741 S ORANGE AVE STE 100
WEST COVINA CA
91790-2662
US

IV. Provider business mailing address

741 S ORANGE AVE STE 100
WEST COVINA CA
91790-2662
US

V. Phone/Fax

Practice location:
  • Phone: 951-289-5424
  • Fax: 760-605-7041
Mailing address:
  • Phone: 951-289-5424
  • Fax: 760-605-7041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JUSTINDER MALTHOTRA
Title or Position: CEO
Credential: MD
Phone: 951-289-5424