Provider Demographics
NPI:1881458891
Name:EMANATE PAIN MANAGEMENT MEDICAL GROUP PC
Entity type:Organization
Organization Name:EMANATE PAIN MANAGEMENT MEDICAL GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DHARMESH
Authorized Official - Middle Name:
Authorized Official - Last Name:MEHTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-689-6090
Mailing Address - Street 1:PO BOX 209
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91723-0209
Mailing Address - Country:US
Mailing Address - Phone:909-803-0647
Mailing Address - Fax:
Practice Address - Street 1:9120 HAVEN AVE STE 202
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-5413
Practice Address - Country:US
Practice Address - Phone:909-803-0647
Practice Address - Fax:626-608-7322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-09
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty