Provider Demographics
NPI:1871942029
Name:EGB HOLDINGS
Entity type:Organization
Organization Name:EGB HOLDINGS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:EMIL
Authorized Official - Middle Name:
Authorized Official - Last Name:BUNDANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-668-9302
Mailing Address - Street 1:PO BOX 261485
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92196-1485
Mailing Address - Country:US
Mailing Address - Phone:714-668-9302
Mailing Address - Fax:714-668-9304
Practice Address - Street 1:151 KALMUS DR
Practice Address - Street 2:SUITE D-104
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-5988
Practice Address - Country:US
Practice Address - Phone:714-668-9302
Practice Address - Fax:714-668-9304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-08
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based