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General NPI Number Information
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NPI Number | 1750454260
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Entity Type | Organization
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Legal Business Name | EMPIRE PHYSICIANS MEDICAL GROUP
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Dates
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Enumeration Date | 11/15/2006
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Last Update Date | 03/06/2013
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Provider Practice Location Address
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Address Line | 34160 GATEWAY DR STE 100
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City | PALM DESERT
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State | CA
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Zip | 92211-0852
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Country | US
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Telephone | 760-770-8678
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Fax | 760-770-7609
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Provider Business Mailing Address
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Address Line | 34160 GATEWAY DR STE 100
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City | PALM DESERT
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State | CA
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Zip | 92211-0852
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Country | US
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Telephone | 760-770-8678
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Fax | 760-770-7609
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. YVONNE SONNENBERG
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Credential | MHA
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Telephone | 760-770-8678
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | FNP28851
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License Number State | CA
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