Basic Information
| Provider Information | |||||||||
| NPI: | 1316069545 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MONTEREY BAY EMERGENCY PHYSICIANS MEDICAL CORPORATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7 CARIBOU CT | ||||||||
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| City: | MONTEREY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939406303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8316461940 | ||||||||
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| Practice Location | |||||||||
| Address1: | 23625 HOLMAN HWY | ||||||||
| Address2: | |||||||||
| City: | MONTEREY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939405902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8316245311 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | NICHOLAS | ||||||||
| AuthorizedOfficialFirstName: | KARL | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO TREASURER | ||||||||
| AuthorizedOfficialTelephone: | 8316461940 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | X | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine | 207PE0004X | X | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine | Emergency Medical Services |
No ID Information.