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General NPI Number Information
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NPI Number | 1669829578
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Entity Type | Organization
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Legal Business Name | CALIFORNIA EMERGENCY PHYSICIANS MEDICAL GROUP, A PROFESSIONAL CORPORAT
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Dates
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Enumeration Date | 05/20/2016
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Last Update Date | 11/16/2016
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Provider Practice Location Address
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Address Line | 1586 W SAN MARCOS BLVD
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City | SAN MARCOS
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State | CA
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Zip | 92078-4019
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Country | US
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Telephone | 760-471-2986
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Fax |
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Provider Business Mailing Address
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Address Line | 2100 POWELL ST SUITE 900
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City | EMERYVILLE
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State | CA
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Zip | 94608-1826
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Country | US
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Telephone | 510-350-2600
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | THEOPHILE KOURY
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Credential | MD
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Telephone | 510-350-2600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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