| Eminence Health Management Inc. | |
|
557 N Central Ave Upland CA 91786-4241 | |
| (909) 608-7178 | |
| (909) 608-0939 |
| Full Name | Eminence Health Management Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 557 N Central Ave, Upland, California |
| Authorized Official Name and Position | Maria Rodriguez (ADMINISTRATOR) |
| Authorized Official Contact | 9096087178 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Eminence Health Management Inc. 557 N Central Ave Upland CA 91786-4241 Ph: (909) 608-7178 | Eminence Health Management Inc. 557 N Central Ave Upland CA 91786-4241 Ph: (909) 608-7178 |
| NPI Number | 1780344820 |
|---|---|
| Provider Enumeration Date | 12/29/2021 |
| Last Update Date | 03/28/2023 |
| Medicare PECOS PAC ID | 8820462385 |
|---|---|
| Medicare Enrollment ID | O20230323001654 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780344820 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Kasein Gonzalez |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1700049459 PECOS PAC ID: 9638326762 Enrollment ID: I20120824000595 |
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