Provider Demographics
NPI:1104218320
Name:EASTERN MEDICAL HEALTH GROUP
Entity Type:Organization
Organization Name:EASTERN MEDICAL HEALTH GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:BERMUDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:818-432-1470
Mailing Address - Street 1:12840 RIVERSIDE DR
Mailing Address - Street 2:SUITE 401
Mailing Address - City:VALLEY VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91607-3327
Mailing Address - Country:US
Mailing Address - Phone:818-432-1470
Mailing Address - Fax:818-432-1472
Practice Address - Street 1:12840 RIVERSIDE DR
Practice Address - Street 2:SUITE 401
Practice Address - City:VALLEY VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91607-3327
Practice Address - Country:US
Practice Address - Phone:818-432-1470
Practice Address - Fax:818-432-1472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-25
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC15484171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty