Healthcare Provider Details

I. General information

NPI: 1174301022
Provider Name (Legal Business Name): EMANATE HEALTH MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2023
Last Update Date: 06/18/2024
Certification Date: 06/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1135 S SUNSET AVE STE 104
WEST COVINA CA
91790-3965
US

IV. Provider business mailing address

1620 W NORTHWEST HWY STE 100
GRAPEVINE TX
76051-3219
US

V. Phone/Fax

Practice location:
  • Phone: 626-732-8670
  • Fax: 626-746-3068
Mailing address:
  • Phone: 817-572-0009
  • Fax: 817-572-0221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: RAJESH SHARMA
Title or Position: PRESIDENT & CEO
Credential:
Phone: 626-938-7595