Healthcare Provider Details

I. General information

NPI: 1407999436
Provider Name (Legal Business Name): CALIFORNIA EMERGENCY PHYSICIAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 02/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

869 N CHERRY ST
TULARE CA
93274-2207
US

IV. Provider business mailing address

282 HEMMINGWAY CT
TULARE CA
93274-6046
US

V. Phone/Fax

Practice location:
  • Phone: 559-688-0821
  • Fax:
Mailing address:
  • Phone: 559-686-7881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License NumberPA18501
License Number StateCA

VIII. Authorized Official

Name: ELTON RAY TRIPP
Title or Position: PHYSICIAN ASSISTANT
Credential: PA-C
Phone: 559-786-7837