Provider Demographics
NPI:1740521707
Name:EAGLE MEDICAL MANAGEMENT, LLC
Entity type:Organization
Organization Name:EAGLE MEDICAL MANAGEMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MGR
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:KAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-532-4790
Mailing Address - Street 1:PO BOX 5490
Mailing Address - Street 2:
Mailing Address - City:NORCO
Mailing Address - State:CA
Mailing Address - Zip Code:92860-8016
Mailing Address - Country:US
Mailing Address - Phone:909-350-7208
Mailing Address - Fax:951-215-2620
Practice Address - Street 1:1900 ROYALTY DR STE 140
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-3044
Practice Address - Country:US
Practice Address - Phone:909-350-7208
Practice Address - Fax:951-215-2620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-14
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty