Healthcare Provider Details

I. General information

NPI: 1447288345
Provider Name (Legal Business Name): TEAM PHYSICIANS OF CALIFORNIA MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 01/10/2020
Certification Date: 01/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 GARCES HWY
DELANO CA
93215-3690
US

IV. Provider business mailing address

PO BOX 634600
CINCINNATI OH
45263-4600
US

V. Phone/Fax

Practice location:
  • Phone: 925-924-1600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SHARON HARDY
Title or Position: DIR PROVIDER ENROLLMENT
Credential:
Phone: 925-251-6901