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General NPI Number Information
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NPI Number | 1154550812
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Entity Type | Organization
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Legal Business Name | EMPIRE MEDICAL GROUP, INC
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Dates
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Enumeration Date | 07/02/2009
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Last Update Date | 11/26/2012
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Provider Practice Location Address
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Address Line | 1906 COMMERCENTER E
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City | SAN BERNARDINO
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State | CA
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Zip | 92408-3422
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Country | US
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Telephone | 626-798-8600
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Fax | 626-798-8842
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Provider Business Mailing Address
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Address Line | 2693 E WASHINGTON BLVD
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City | PASADENA
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State | CA
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Zip | 91107-1412
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Country | US
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Telephone | 626-798-8600
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Fax | 626-798-8842
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Authorized Official
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Title or Position | CEO
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Name | DR. WALTER JAYASHINGHE
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Credential | M.D.
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Telephone | 951-280-7700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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