Healthcare Provider Details

I. General information

NPI: 1265810006
Provider Name (Legal Business Name): CAN EMERGENCY PHYSICIANS MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2015
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14850 ROSCOE BLVD
PANORAMA CITY CA
91402-4618
US

IV. Provider business mailing address

2550 N HOLLYWOOD WAY STE 304
BURBANK CA
91505-5028
US

V. Phone/Fax

Practice location:
  • Phone: 408-559-2011
  • Fax:
Mailing address:
  • Phone: 747-283-1809
  • 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: PHILIP J, FAGAN JR.
Title or Position: PRESIDENT
Credential: M.D.
Phone: 747-283-1809