Provider Demographics
NPI:1447532650
Name:LA JOLLA EMERGENCY ENTERPRISES, INC.
Entity type:Organization
Organization Name:LA JOLLA EMERGENCY ENTERPRISES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TALAL
Authorized Official - Middle Name:ABDULLAH
Authorized Official - Last Name:AL-QURAINI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-361-8004
Mailing Address - Street 1:6136 CARDENO DR
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-6924
Mailing Address - Country:US
Mailing Address - Phone:858-361-8004
Mailing Address - Fax:
Practice Address - Street 1:1101 N. PACIFIC AVE.
Practice Address - Street 2:SUITE 104
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91202-4313
Practice Address - Country:US
Practice Address - Phone:818-552-5000
Practice Address - Fax:818-956-0990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-13
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA61433207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABA802ZMedicare PIN