Healthcare Provider Details

I. General information

NPI: 1316113145
Provider Name (Legal Business Name): CALIFORNIA HEALTHFIRST PHYSICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2008
Last Update Date: 07/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 N ORANGE ST SUITE 200
GLENDALE CA
91203-1911
US

IV. Provider business mailing address

PO BOX 10968
SAN BERNARDINO CA
92423-0968
US

V. Phone/Fax

Practice location:
  • Phone: 818-291-9747
  • Fax: 818-662-9685
Mailing address:
  • Phone: 909-335-7171
  • Fax: 909-335-7140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: LISA PERKO
Title or Position: CFO
Credential:
Phone: 909-335-7171