Healthcare Provider Details

I. General information

NPI: 1447484274
Provider Name (Legal Business Name): CEP AMERICA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2009
Last Update Date: 04/01/2020
Certification Date: 04/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21601 76TH AVE W
EDMONDS WA
98026-7507
US

IV. Provider business mailing address

1601 CUMMINS DR STE D
MODESTO CA
95358-6411
US

V. Phone/Fax

Practice location:
  • Phone: 425-640-4000
  • Fax: 425-640-4024
Mailing address:
  • Phone: 510-350-2600
  • Fax: 510-879-9100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: DAVID BIRDSALL
Title or Position: COO
Credential: M.D.
Phone: 510-350-2600