Provider Demographics
NPI:1790187342
Name:EMESTON MEDIC
Entity Type:Organization
Organization Name:EMESTON MEDIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:G
Authorized Official - Last Name:UDOH
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACY TECHNICIAN
Authorized Official - Phone:925-727-8182
Mailing Address - Street 1:PO BOX 1566
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94587-6566
Mailing Address - Country:US
Mailing Address - Phone:925-727-8182
Mailing Address - Fax:925-241-4072
Practice Address - Street 1:975 CORPORATE WAY
Practice Address - Street 2:SUITE H
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94539-6118
Practice Address - Country:US
Practice Address - Phone:925-727-8182
Practice Address - Fax:925-241-4072
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EMESTON MEDIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-09-25
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA107469343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)