Provider Demographics
NPI:1073003000
Name:IMPACT CARE ACCESS NETWORK II
Entity Type:Organization
Organization Name:IMPACT CARE ACCESS NETWORK II
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-CEO
Authorized Official - Prefix:
Authorized Official - First Name:EMANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:JEANPIERRE
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:760-998-3550
Mailing Address - Street 1:9390 HESPERIA RD STE 7
Mailing Address - Street 2:
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-3602
Mailing Address - Country:US
Mailing Address - Phone:760-998-3550
Mailing Address - Fax:760-998-3552
Practice Address - Street 1:9390 HESPERIA RD STE 7
Practice Address - Street 2:
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-3602
Practice Address - Country:US
Practice Address - Phone:760-998-3550
Practice Address - Fax:760-998-3552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-15
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty