Provider Demographics
NPI:1073680757
Name:EL MONTE FAMILY MEDICAL GROUP
Entity Type:Organization
Organization Name:EL MONTE FAMILY MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:WAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DAGHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-442-7077
Mailing Address - Street 1:11227 VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91731
Mailing Address - Country:US
Mailing Address - Phone:626-442-7077
Mailing Address - Fax:626-442-2640
Practice Address - Street 1:11227 VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91731
Practice Address - Country:US
Practice Address - Phone:626-442-7077
Practice Address - Fax:626-442-2640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1073680757Medicaid
CA1073680757Medicaid