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General NPI Number Information
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NPI Number | 1407999436
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Entity Type | Organization
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Legal Business Name | CALIFORNIA EMERGENCY PHYSICIAN
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Dates
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Enumeration Date | 02/15/2007
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Last Update Date | 02/09/2009
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Provider Practice Location Address
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Address Line | 869 N CHERRY ST
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City | TULARE
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State | CA
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Zip | 93274-2207
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Country | US
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Telephone | 559-688-0821
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Fax |
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Provider Business Mailing Address
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Address Line | 282 HEMMINGWAY CT
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City | TULARE
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State | CA
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Zip | 93274-6046
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Country | US
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Telephone | 559-686-7881
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN ASSISTANT
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Name | ELTON RAY TRIPP
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Credential | PA-C
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Telephone | 559-786-7837
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0002X
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Taxonomy Name | Emergency Care Clinic/Center
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License Number | PA18501
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License Number State | CA
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