Provider Demographics
NPI:1437493970
Name:EQUALITY, AN INDEPENDENT PRACTICE ASSOCIATION, INC., A MEDICAL GROUP
Entity Type:Organization
Organization Name:EQUALITY, AN INDEPENDENT PRACTICE ASSOCIATION, INC., A MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LAN
Authorized Official - Middle Name:NHU BICH
Authorized Official - Last Name:PHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-399-8996
Mailing Address - Street 1:2360 HUNTINGTON DR STE 201
Mailing Address - Street 2:SAN MARINO
Mailing Address - City:SAN MARINO
Mailing Address - State:CA
Mailing Address - Zip Code:91108-2651
Mailing Address - Country:US
Mailing Address - Phone:818-399-8996
Mailing Address - Fax:
Practice Address - Street 1:2360 HUNTINGTON DR STE 201
Practice Address - Street 2:SAN MARINO
Practice Address - City:SAN MARINO
Practice Address - State:CA
Practice Address - Zip Code:91108-2651
Practice Address - Country:US
Practice Address - Phone:818-399-8996
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-21
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization