Basic Information
| Provider Information | |||||||||
| NPI: | 1265706386 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CALIFORNIA EM-I MEDICAL SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 815 S PALAFOX ST | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | PENSACOLA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325025960 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8004447009 | ||||||||
| FaxNumber: | 8003053233 | ||||||||
| Practice Location | |||||||||
| Address1: | 240 SPRUCE ST | ||||||||
| Address2: | |||||||||
| City: | GRIDLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959482216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5308466406 | ||||||||
| FaxNumber: | 8003053233 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2012 | ||||||||
| LastUpdateDate: | 07/13/2012 | ||||||||
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| AuthorizedOfficialLastName: | ISCOVICH | ||||||||
| AuthorizedOfficialFirstName: | ANGEL | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8055633011 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 207P00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine | 363A00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.