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General NPI Number Information
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NPI Number | 1316996564
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Entity Type | Organization
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Legal Business Name | PREMIER EMERGENCY PHYSICIANS OF CALIFORNIA MEDICAL GROUP PC
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Dates
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Enumeration Date | 05/07/2006
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Last Update Date | 04/09/2021
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Provider Practice Location Address
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Address Line | 2131 W 3RD ST
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City | LOS ANGELES
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State | CA
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Zip | 90057-1901
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Country | US
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Telephone | 213-484-7301
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 13880
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City | PHILADELPHIA
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State | PA
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Zip | 19101-3880
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Country | US
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Telephone |
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Fax | 805-564-5087
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Authorized Official
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Title or Position | OFFICER
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Name | KATHY KONDAS
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Credential |
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Telephone | 973-251-1132
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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