Basic Information
| Provider Information | |||||||||
| NPI: | 1053445072 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ENGLISH | ||||||||
| FirstName: | EMANUEL | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | SR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2610 INDUSTRY WAY | ||||||||
| Address2: | SUITE A | ||||||||
| City: | LYNWOOD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902624283 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3105379780 | ||||||||
| FaxNumber: | 3105379753 | ||||||||
| Practice Location | |||||||||
| Address1: | 3320 W ADAMS BLVD | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900181838 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3105379780 | ||||||||
| FaxNumber: | 3105379753 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2007 | ||||||||
| LastUpdateDate: | 06/14/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225400000X | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Practitioner | 172V00000X | Y | Other Service Providers | Community Health Worker |
No ID Information.