Healthcare Provider Details

I. General information

NPI: 1326577206
Provider Name (Legal Business Name): CALIFORNIA EMERGENCY PHYSICIANS MEDICAL GROUP, A PROFESSIONAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2017
Last Update Date: 06/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15891 LOS GATOS ALMADEN RD
LOS GATOS CA
95032-3742
US

IV. Provider business mailing address

2100 POWELL ST
EMERYVILLE CA
94608-1826
US

V. Phone/Fax

Practice location:
  • Phone: 408-559-2011
  • Fax:
Mailing address:
  • Phone: 510-350-2638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID BIRDSALL
Title or Position: C.O.O
Credential: MD
Phone: 510-350-2600