Provider Demographics
NPI:1093838765
Name:HEALTH EDUCATORS MEDICAL GROUP
Entity Type:Organization
Organization Name:HEALTH EDUCATORS MEDICAL GROUP
Other - Org Name:DIABETES HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IRVING
Authorized Official - Middle Name:L
Authorized Official - Last Name:SPRATT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-881-7623
Mailing Address - Street 1:399 E HIGHLAND AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92404-3842
Mailing Address - Country:US
Mailing Address - Phone:909-881-7623
Mailing Address - Fax:
Practice Address - Street 1:399 E HIGHLAND AVE STE 110
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-3842
Practice Address - Country:US
Practice Address - Phone:909-881-7623
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG40250207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ82158ZMedicaid
CAZZZ82158ZMedicaid