Provider Demographics
NPI:1477797306
Name:ECLAT MEDICAL, INC
Entity Type:Organization
Organization Name:ECLAT MEDICAL, INC
Other - Org Name:HUNTINGTON HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHUNPEI
Authorized Official - Middle Name:
Authorized Official - Last Name:IWATA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-535-0900
Mailing Address - Street 1:2275 HUNTINGTON DR
Mailing Address - Street 2:#861
Mailing Address - City:SAN MARINO
Mailing Address - State:CA
Mailing Address - Zip Code:91108-2640
Mailing Address - Country:US
Mailing Address - Phone:626-535-0900
Mailing Address - Fax:626-389-5479
Practice Address - Street 1:800 FAIRMOUNT AVE STE 410
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3154
Practice Address - Country:US
Practice Address - Phone:626-535-0900
Practice Address - Fax:626-389-5479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-22
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA95845261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care