Healthcare Provider Details

I. General information

NPI: 1144505066
Provider Name (Legal Business Name): PREMIER EMERGENCY PHYSICIANS OF CALIFORNIA MEDICAL GROUP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2011
Last Update Date: 04/09/2021
Certification Date: 04/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43563 STATE HIGHWAY 299 E
FALL RIVER MILLS CA
96028-9787
US

IV. Provider business mailing address

815 S PALAFOX ST SUITE 300
PENSACOLA FL
32502-5960
US

V. Phone/Fax

Practice location:
  • Phone: 530-336-5511
  • Fax:
Mailing address:
  • Phone: 800-444-7009
  • Fax: 800-305-3233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: KATHY KONDAS
Title or Position: OFFICER
Credential:
Phone: 973-251-1132