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General NPI Number Information
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NPI Number | 1255041018
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Entity Type | Organization
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Legal Business Name | E.T. MEDICAL SERVICES LLC
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Dates
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Enumeration Date | 12/01/2022
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Last Update Date | 12/01/2022
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Provider Practice Location Address
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Address Line | 8300 UTICA AVE # 157B
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-3879
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Country | US
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Telephone | 909-941-1511
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Fax | 909-941-1211
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Provider Business Mailing Address
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Address Line | 12228 CHORUS DR
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91739-8757
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Country | US
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Telephone | 818-640-6270
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Fax | 909-941-1211
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Authorized Official
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Title or Position | OWNER
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Name | ADNAN GHASSAN ABDELAZIZ
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Credential |
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Telephone | 818-640-6270
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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