| Pacific Empire Physical Medicine And Healthcare Inc | |
|
4590 Riverside Dr Chino CA 91710-3980 | |
| (909) 464-9880 | |
| (909) 591-4720 |
| Full Name | Pacific Empire Physical Medicine And Healthcare Inc |
|---|---|
| Speciality | General Practice |
| Location | 4590 Riverside Dr, Chino, California |
| Authorized Official Name and Position | Ali Halati (DIRECTOR) |
| Authorized Official Contact | 9094649880 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pacific Empire Physical Medicine And Healthcare Inc 4590 Riverside Dr Chino CA 91710-3980 Ph: (909) 464-9880 | Pacific Empire Physical Medicine And Healthcare Inc 4590 Riverside Dr Chino CA 91710-3980 Ph: (909) 464-9880 |
| NPI Number | 1912385451 |
|---|---|
| Provider Enumeration Date | 05/17/2015 |
| Last Update Date | 09/21/2015 |
| Medicare PECOS PAC ID | 9830406214 |
|---|---|
| Medicare Enrollment ID | O20150917000355 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912385451 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | A92433 (California) | Primary |
| 364SF0001X | Clinical Nurse Specialist - Family Health | PA18558 (California) | Secondary |
| Provider Name | Gary L Sannes |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1568519460 PECOS PAC ID: 6800948902 Enrollment ID: I20090721000672 |
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