Basic Information
| Provider Information | |||||||||
| NPI: | 1154310282 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CALIFORNIA EMERGENCY PHYSICIANS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5738 N VAN NESS BLVD | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937111203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5599777644 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1250 E ALMOND AVE | ||||||||
| Address2: | |||||||||
| City: | MADERA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 936375606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5596755520 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/20/2005 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | STEFANOPOULOS | ||||||||
| AuthorizedOfficialFirstName: | STACY | ||||||||
| AuthorizedOfficialMiddleName: | M. | ||||||||
| AuthorizedOfficialTitleorPosition: | ACUTE CARE NURSE PRACTITIONER | ||||||||
| AuthorizedOfficialTelephone: | 5596755520 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | RN, ACNP, BC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 15195 | CA | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 568186 | 01 | CA | BRN # | OTHER |