Healthcare Provider Details

I. General information

NPI: 1730139908
Provider Name (Legal Business Name): NORTH COAST EMERGENCY PHYSICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 DOLBEER ST
EUREKA CA
95501-4736
US

IV. Provider business mailing address

PO BOX 81461
SAN DIEGO CA
92138-1461
US

V. Phone/Fax

Practice location:
  • Phone: 707-269-4250
  • Fax:
Mailing address:
  • Phone: 619-285-5996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: RONALD CORDOVA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 707-269-4250