Healthcare Provider Details

I. General information

NPI: 1184647059
Provider Name (Legal Business Name): CALIFORNIA EMERGENCY PHYSICIANS MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 01/13/2020
Certification Date: 01/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8833 MONTEREY RD SUITE H
GILROY CA
95020
US

IV. Provider business mailing address

1601 CUMMINS DR STE D
MODESTO CA
95358-6411
US

V. Phone/Fax

Practice location:
  • Phone: 408-842-1544
  • Fax:
Mailing address:
  • Phone: 510-851-7423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: THEOPHILE KOURY
Title or Position: COO
Credential: M.D.
Phone: 510-350-2770