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General NPI Number Information
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NPI Number | 1518043264
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Entity Type | Organization
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Legal Business Name | EMMANUEL MEDICAL CORPORATION
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Dates
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Enumeration Date | 10/27/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1817 W BEVERLY BLVD
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City | MONTEBELLO
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State | CA
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Zip | 90640-3935
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Country | US
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Telephone | 323-721-5524
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Fax | 323-837-1465
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Provider Business Mailing Address
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Address Line | 1817 W BEVERLY BLVD
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City | MONTEBELLO
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State | CA
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Zip | 90640-3935
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Country | US
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Telephone | 323-721-5524
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Fax | 323-837-1465
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LUIS HERNANDEZ
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Credential | M.D.
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Telephone | 323-721-5524
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number |
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License Number State | CA
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