Provider Demographics
NPI:1801843917
Name:ANAHEIM MEMORIAL HOSPITAL EMERGENCY PHYSICIANS MEDICAL GROUP
Entity Type:Organization
Organization Name:ANAHEIM MEMORIAL HOSPITAL EMERGENCY PHYSICIANS MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IGNACIO
Authorized Official - Middle Name:
Authorized Official - Last Name:ZARATE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-809-3543
Mailing Address - Street 1:PO BOX 10070
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92685-0070
Mailing Address - Country:US
Mailing Address - Phone:562-809-3543
Mailing Address - Fax:
Practice Address - Street 1:1111 W LA PALMA AVE
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-2804
Practice Address - Country:US
Practice Address - Phone:714-774-1450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0095200Medicaid
CAHW17198Medicare PIN