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General NPI Number Information
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NPI Number | 1184309411
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Entity Type | Organization
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Legal Business Name | SENIOR HEALTH ASSOCIATES A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 06/15/2023
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Last Update Date | 06/15/2023
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Provider Practice Location Address
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Address Line | 741 S ORANGE AVE STE 100
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City | WEST COVINA
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State | CA
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Zip | 91790-2662
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Country | US
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Telephone | 951-289-5424
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Fax | 760-605-7041
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Provider Business Mailing Address
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Address Line | 741 S ORANGE AVE STE 100
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City | WEST COVINA
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State | CA
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Zip | 91790-2662
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Country | US
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Telephone | 951-289-5424
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Fax | 760-605-7041
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Authorized Official
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Title or Position | CEO
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Name | JUSTINDER MALTHOTRA
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Credential | MD
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Telephone | 951-289-5424
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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