Provider Demographics
NPI:1700198447
Name:EAGLE-1 HEALTHCARE INC
Entity Type:Organization
Organization Name:EAGLE-1 HEALTHCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:T
Authorized Official - Last Name:PFUPAJENA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-426-0555
Mailing Address - Street 1:240 N VIRGIL AVE
Mailing Address - Street 2:7
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004-5399
Mailing Address - Country:US
Mailing Address - Phone:213-426-0555
Mailing Address - Fax:213-739-8843
Practice Address - Street 1:240 N VIRGIL AVE
Practice Address - Street 2:7
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-5399
Practice Address - Country:US
Practice Address - Phone:213-426-0555
Practice Address - Fax:213-739-8843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-10
Last Update Date:2010-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG29345208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG 29345Medicare PIN