1518904150 NPI number — SHERMAN OAKS EMERGENCY MEDICAL ASSOCIATES

Table of content: ALEXIS HENNIGAR PT, DPT (NPI 1891500096)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518904150 NPI number — SHERMAN OAKS EMERGENCY MEDICAL ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHERMAN OAKS EMERGENCY MEDICAL ASSOCIATES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518904150
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 80616
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CITY OF INDUSTRY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91716-8411
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-321-0143
Provider Business Mailing Address Fax Number:
310-379-4856

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4929 VAN NUYS BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHERMAN OAKS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91403-1702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-379-2134
Provider Business Practice Location Address Fax Number:
310-379-4856
Provider Enumeration Date:
06/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
EDWARDS
Authorized Official First Name:
IRV
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
310-321-0143

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: GR0102970 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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