Organization
LARRY I. EMDUR, D.O., PHD.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LARRY I EMDUR D.O. (PRESIDENT,OWNER)
(619) 286-8803
Entity
Organization
Contact information
Practice address
5555 RESERVOIR DR, 201, SAN DIEGO, CA 92120-5134
(619) 286-8803
(619) 286-2344
Mailing address
5173 WARING RD, SUITE 125, SAN DIEGO, CA 92120-2705
(619) 286-8803
(619) 286-2344
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
20A4940
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20A4940
CA STATE LICENSE
CA
01
—
GR0044140
MEDI-CA;
CA
Enumeration date
02/09/2007
Last updated
08/06/2012
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