Healthcare Provider Details

I. General information

NPI: 1417622374
Provider Name (Legal Business Name): STATE OF CALIFORNIA EMERGENCY MEDICAL SERVICES AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2021
Last Update Date: 08/12/2021
Certification Date: 08/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10901 GOLD CENTER DRIVE SUITE 400
RANCHO CORDOVA CA
95670
US

IV. Provider business mailing address

10901 GOLD CENTER DRIVE SUITE 400
RANCHO CORDOVA CA
95670
US

V. Phone/Fax

Practice location:
  • Phone: 916-322-4336
  • Fax:
Mailing address:
  • Phone: 916-322-4336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1000X
TaxonomyMigrant Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: DAVID DUNCAN
Title or Position: DIRECTOR
Credential: M.D.
Phone: 916-431-3716