Provider Demographics
NPI:1144308644
Name:CONANAN, EMMANUEL C (MD)
Entity type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:C
Last Name:CONANAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 W GRANGEVILLE BLVD
Mailing Address - Street 2:STE A
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230-2858
Mailing Address - Country:US
Mailing Address - Phone:510-625-6262
Mailing Address - Fax:
Practice Address - Street 1:560 W GRANGEVILLE BLVD
Practice Address - Street 2:STE A
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-2858
Practice Address - Country:US
Practice Address - Phone:559-448-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA71983207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A719830Medicaid
CA00A719830Medicaid