1447532650 NPI number — LA JOLLA EMERGENCY ENTERPRISES, INC.

Table of content: (NPI 1447532650)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447532650 NPI number — LA JOLLA EMERGENCY ENTERPRISES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LA JOLLA EMERGENCY ENTERPRISES, INC.
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:
1447532650
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/04/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6136 CARDENO DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LA JOLLA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92037-6924
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
858-361-8004
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1101 N. PACIFIC AVE.
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
GLENDALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91202-4313
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-552-5000
Provider Business Practice Location Address Fax Number:
818-956-0990
Provider Enumeration Date:
09/13/2011

Additional Information

Authorized Official

Authorized Official Last Name:
AL-QURAINI
Authorized Official First Name:
TALAL
Authorized Official Middle Name:
ABDULLAH
Authorized Official Title or Position:
PRESIDENT/OWNER
Authorized Official Telephone Number:
858-361-8004

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  A61433 , 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)





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