Provider Demographics
NPI:1528537834
Name:EMANA MEDICAL
Entity Type:Organization
Organization Name:EMANA MEDICAL
Other - Org Name:EMANA MEDICAL
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EMANA
Authorized Official - Middle Name:
Authorized Official - Last Name:ADBALLAH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:310-878-4321
Mailing Address - Street 1:435 N BEDFORD DR STE 305
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4348
Mailing Address - Country:US
Mailing Address - Phone:310-878-4321
Mailing Address - Fax:
Practice Address - Street 1:435 N BEDFORD DR STE 305
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4348
Practice Address - Country:US
Practice Address - Phone:310-878-4321
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-15
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1528321957OtherINDIVIDUAL NPI