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General NPI Number Information
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NPI Number | 1588249569
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Entity Type | Organization
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Legal Business Name | NES WESTERN GROUP, A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 03/11/2021
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Last Update Date | 10/25/2024
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Provider Practice Location Address
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Address Line | 27200 CALAROGA AVE
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City | HAYWARD
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State | CA
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Zip | 94545-4339
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Country | US
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Telephone | 510-264-4000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 31117
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City | BELFAST
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State | ME
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Zip | 04915-0140
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Country | US
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Telephone | 800-377-8721
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Fax |
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Authorized Official
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Title or Position | PROVIDER ENROLLMENT
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Name | JENNIFER BLAKEMAN
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Credential |
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Telephone | 469-557-6183
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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