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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 : 1457945990
Entity Type Code : Organization
Provider Name (Legal Business Name) : CALIFORNIA EMERGENCY PHYSICIANS MEDICAL GROUP, A PROFESSIONAL CORP.
Provider Business Mailing Address
First Line : 2100 POWELL ST STE 400
Second Line :
City : EMERYVILLE
State : CA
Zip : 94608-1826
Country : US
Telephone Number : 510-350-2638
Fax Number :
Provider Business Practice Location Address
First Line : 33 MATEO AVE
Second Line :
City : MILLBRAE
State : CA
Zip : 94030-2037
Country : US
Telephone Number : 650-689-5784
Fax Number :
Authorized Official
Title or Position : CHIEF OPERATIONS OFFICER
Name : DAVID BIRDSALL
Credential : M.D
Telephone Number : 510-350-2638
Provider Enumeration Date : 02/25/2021
Last Update Date : 02/25/2021

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