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General NPI Number Information
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NPI Number | 1447288345
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Entity Type | Organization
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Legal Business Name | TEAM PHYSICIANS OF CALIFORNIA MEDICAL GROUP INC
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Dates
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Enumeration Date | 06/29/2006
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Last Update Date | 01/10/2020
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Provider Practice Location Address
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Address Line | 1401 GARCES HWY
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City | DELANO
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State | CA
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Zip | 93215-3690
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Country | US
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Telephone | 925-924-1600
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 634600
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City | CINCINNATI
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State | OH
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Zip | 45263-4600
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIR PROVIDER ENROLLMENT
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Name | SHARON HARDY
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Credential |
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Telephone | 925-251-6901
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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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