Provider Demographics
NPI:1003252016
Name:EMERE MEDICAL PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:EMERE MEDICAL PROFESSIONAL CORPORATION
Other - Org Name:EMERE-SOUTH BAY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN / MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARYAM
Authorized Official - Middle Name:
Authorized Official - Last Name:RAHIMI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:310-750-2440
Mailing Address - Street 1:801 N 500 W
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-6829
Mailing Address - Country:US
Mailing Address - Phone:801-617-2100
Mailing Address - Fax:801-208-7050
Practice Address - Street 1:23430 HAWTHORNE BLVD
Practice Address - Street 2:SUITE 125
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-4724
Practice Address - Country:US
Practice Address - Phone:310-750-2440
Practice Address - Fax:310-750-2448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-16
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGQ002AMedicare PIN