Individual
DR. LARRY I EMDUR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO, PHD
Contact information
Practice address
6719 ALVARADO RD, #108, SAN DIEGO, CA 92120-5270
(619) 286-8803
(619) 286-2344
Mailing address
6699 ALVARADO RD, STE 2309, SAN DIEGO, CA 92120-5241
(619) 698-3004
(619) 698-9480
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
20A4940
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00AX4940
MEDI-CAL
CA
01
—
20A4940
LICENSE
CA
01
—
ZZZ39696Z
BLUE CROSS
CA
Enumeration date
07/22/2005
Last updated
06/06/2022
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