Basic Information
| Provider Information | |||||||||
| NPI: | 1033399415 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CALIFORNIA HEALTHFIRST PHYSICIANS | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 10968 | ||||||||
| Address2: | |||||||||
| City: | SAN BERNARDINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 924230968 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9093357171 | ||||||||
| FaxNumber: | 9093357140 | ||||||||
| Practice Location | |||||||||
| Address1: | 5051 VERDUGO WAY STE 100 | ||||||||
| Address2: | |||||||||
| City: | CAMARILLO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930128681 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8053848071 | ||||||||
| FaxNumber: | 8059871927 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/14/2007 | ||||||||
| LastUpdateDate: | 11/04/2009 | ||||||||
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| AuthorizedOfficialLastName: | PERKO | ||||||||
| AuthorizedOfficialFirstName: | LISA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 9093357171 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 207N00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Dermatology | 363LF0000X | NP17104 | CA | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 367A00000X | NMW1008 | CA | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife | 207V00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 1033399415 | 05 | CA | MEDICAID | ZZZ50355Y | 01 | CA | BS/TRIWEST | OTHER |