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NPI Code Detail

MEDICARE: CALIFORNIA EMERGENCY PHYSICIANS MEDICAL GROUP A PROFESSIONAL CORP

MEDICARE: CALIFORNIA EMERGENCY PHYSICIANS MEDICAL GROUP A PROFESSIONAL CORP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician

General Provider Information

NPI Number : 1093196925
Entity Type Code : Organization
Provider Name (Legal Business Name) : CALIFORNIA EMERGENCY PHYSICIANS MEDICAL GROUP A PROFESSIONAL CORP
Provider Business Mailing Address
First Line : 1601 CUMMINS DR STE D
Second Line :
City : MODESTO
State : CA
Zip : 95358-6411
Country : US
Telephone Number : 510-350-2600
Fax Number :
Provider Business Practice Location Address
First Line : 1260 E OHIO AVE
Second Line :
City : ESCONDIDO
State : CA
Zip : 92027-3054
Country : US
Telephone Number : 790-746-1100
Fax Number :
Authorized Official
Title or Position : CHIEF OPERATIONS OFFICER
Name : DAVID BIRDSALL
Credential : MD
Telephone Number : 510-350-2600
Provider Enumeration Date : 06/16/2015
Last Update Date : 03/30/2020

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