Healthcare Provider Details

I. General information

NPI: 1588249569
Provider Name (Legal Business Name): NES WESTERN GROUP, A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2021
Last Update Date: 10/25/2024
Certification Date: 10/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27200 CALAROGA AVE
HAYWARD CA
94545-4339
US

IV. Provider business mailing address

PO BOX 31117
BELFAST ME
04915-0140
US

V. Phone/Fax

Practice location:
  • Phone: 510-264-4000
  • Fax:
Mailing address:
  • Phone: 800-377-8721
  • 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: JENNIFER BLAKEMAN
Title or Position: PROVIDER ENROLLMENT
Credential:
Phone: 469-557-6183