Healthcare Provider Details

I. General information

NPI: 1821237371
Provider Name (Legal Business Name): CALIFORNIA EM-I MEDICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2009
Last Update Date: 01/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15630 18TH AVE
CLEARLAKE CA
95422-9336
US

IV. Provider business mailing address

3916 STATE ST #300
SANTA BARBARA CA
93105-5602
US

V. Phone/Fax

Practice location:
  • Phone: 707-995-5890
  • Fax:
Mailing address:
  • Phone: 805-563-3011
  • Fax: 805-564-5087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateCA

VIII. Authorized Official

Name: ANGEL L ISCOVICH
Title or Position: PRESIDENT
Credential: MD
Phone: 805-563-3011