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General NPI Number Information
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NPI Number | 1881619344
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Entity Type | Organization
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Legal Business Name | EMANATE HEALTH MEDICAL CENTER
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Dates
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Enumeration Date | 07/13/2006
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Last Update Date | 10/27/2020
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Provider Practice Location Address
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Address Line | 210 W SAN BERNARDINO RD
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City | COVINA
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State | CA
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Zip | 91723-1515
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Country | US
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Telephone | 626-331-7331
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Fax | 626-732-3191
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Provider Business Mailing Address
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Address Line | PO BOX 840145
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City | LOS ANGELES
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State | CA
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Zip | 90084-0145
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Country | US
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Telephone | 626-331-7331
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Fax | 626-732-3191
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Authorized Official
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Title or Position | EXECUTIVE VP/CFO
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Name | ROGER SHARMA
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Credential |
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Telephone | 626-938-7595
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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