Healthcare Provider Details

I. General information

NPI: 1760648539
Provider Name (Legal Business Name): CALIFORNIA HOSPITALISTS EMERGENCY PHYSICIANS MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2008
Last Update Date: 08/03/2022
Certification Date: 08/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13222 BLOOMFIELD AVE
NORWALK CA
90650-3249
US

IV. Provider business mailing address

24955 PACIFIC COAST HWY SUITE C-202
MALIBU CA
90265-4700
US

V. Phone/Fax

Practice location:
  • Phone: 747-283-1809
  • Fax:
Mailing address:
  • Phone: 310-839-6175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberC32505
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberC32505
License Number StateCA

VIII. Authorized Official

Name: DR. PHILIP J FAGAN JR.
Title or Position: PRESIDENT/MEDICAL DIRECTOR
Credential: M.D.
Phone: 310-678-7647