# EMERALD ISLE MEDICAL GROUP INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063601946
- **Authorized official:** DR. BERTRAND DE SILVA M.D. (OWNER)
- **Authorized official phone:** (714) 444-0440

## Contact information

- **Practice address:** 4121 BROCKTON AVE STE 104, RIVERSIDE, CA 92501-3442
- **Practice address phone:** (951) 778-0032
- **Mailing address:** 4121 BROCKTON AVE STE 104, RIVERSIDE, CA 92501-3442
- **Mailing address phone:** (951) 778-0032

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | A46400 | CA | — |
| 207RC0200X | Critical Care Medicine (Internal Medicine) Physician | A46400 | CA | — |
| 207RP1001X | Pulmonary Disease Physician | A46400 | CA | — |
| 207RS0012X | Sleep Medicine (Internal Medicine) Physician | A46400 | CA | Yes |

## Other

- **Enumeration date:** 10/17/2007
- **Last updated:** 02/07/2020