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General NPI Number Information
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NPI Number | 1417622374
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Entity Type | Organization
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Legal Business Name | STATE OF CALIFORNIA EMERGENCY MEDICAL SERVICES AUTHORITY
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Dates
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Enumeration Date | 08/12/2021
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Last Update Date | 08/12/2021
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Provider Practice Location Address
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Address Line | 10901 GOLD CENTER DRIVE SUITE 400
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City | RANCHO CORDOVA
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State | CA
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Zip | 95670
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Country | US
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Telephone | 916-322-4336
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Fax |
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Provider Business Mailing Address
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Address Line | 10901 GOLD CENTER DRIVE SUITE 400
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City | RANCHO CORDOVA
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State | CA
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Zip | 95670
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Country | US
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Telephone | 916-322-4336
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DAVID DUNCAN
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Credential | M.D.
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Telephone | 916-431-3716
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1000X
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Taxonomy Name | Migrant Health Clinic/Center
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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 | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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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 | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number |
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License Number State |
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