Healthcare Provider Details

I. General information

NPI: 1629814736
Provider Name (Legal Business Name): CEP AMERICA-CALIFORNIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2024
Last Update Date: 07/08/2024
Certification Date: 07/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 N TRACY BLVD
TRACY CA
95376-3451
US

IV. Provider business mailing address

2100 POWELL ST STE 400
EMERYVILLE CA
94608-1872
US

V. Phone/Fax

Practice location:
  • Phone: 209-835-1500
  • Fax:
Mailing address:
  • Phone: 510-851-7501
  • 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: DAVID BIRDSALL
Title or Position: CHIEF OPERATIONS OFFICER
Credential: MD
Phone: 510-851-7552