Healthcare Provider Details

I. General information

NPI: 1205071776
Provider Name (Legal Business Name): ALPINE EMERGENCY PHYSICIANS MEDICAL GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2008
Last Update Date: 01/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 ROSS AVE
EL CENTRO CA
92243-4306
US

IV. Provider business mailing address

PO BOX 12439
WESTMINSTER CA
92685-2439
US

V. Phone/Fax

Practice location:
  • Phone: 760-339-7100
  • Fax:
Mailing address:
  • Phone: 888-517-2788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number StateCA

VIII. Authorized Official

Name: STEVEN P MARON
Title or Position: PRESIDENT
Credential: MD
Phone: 760-339-7100