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General NPI Number Information
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NPI Number | 1922041870
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Entity Type | Organization
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Legal Business Name | ENNEAD ENTERPRISES CORP.
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Dates
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Enumeration Date | 06/14/2006
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Last Update Date | 04/07/2009
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Provider Practice Location Address
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Address Line | 23501 CINEMA DR. SUITE 100
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City | VALENCIA
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State | CA
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Zip | 91355
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Country | US
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Telephone | 661-255-2880
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Fax | 661-255-2190
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Provider Business Mailing Address
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Address Line | 2426 CAROL PARK PL
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City | MONTROSE
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State | CA
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Zip | 91020-1112
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Country | US
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Telephone | 661-255-2880
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Fax | 661-255-2190
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Authorized Official
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Title or Position | PRESIDENT, MEDICAL AFFAIRS
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Name | MR. KEVIN SCOTT TRABER
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Credential | RN
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Telephone | 661-255-2880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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