Healthcare Provider Details

I. General information

NPI: 1902254758
Provider Name (Legal Business Name): CALIFORNIA EMERGENCY PHYSICIANS MEDICAL GROUP, A PROFESSIONAL CORPORAT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2016
Last Update Date: 06/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 POWELL ST SUITE 900
EMERYVILLE CA
94608-1826
US

IV. Provider business mailing address

1025 W 2ND AVE
ESCONDIDO CA
92025-3839
US

V. Phone/Fax

Practice location:
  • Phone: 510-350-2680
  • Fax:
Mailing address:
  • Phone: 760-745-1842
  • Fax: 760-745-4346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: THEOPHILE KOURY
Title or Position: PRESIDENT
Credential: MD
Phone: 510-350-2600