Basic Information
| Provider Information | |||||||||
| NPI: | 1407999436 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CALIFORNIA EMERGENCY PHYSICIAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 282 HEMMINGWAY CT | ||||||||
| Address2: | |||||||||
| City: | TULARE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932746046 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5596867881 | ||||||||
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| Practice Location | |||||||||
| Address1: | 869 N CHERRY ST | ||||||||
| Address2: | |||||||||
| City: | TULARE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932742207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5596880821 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2007 | ||||||||
| LastUpdateDate: | 02/09/2009 | ||||||||
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| AuthorizedOfficialLastName: | TRIPP | ||||||||
| AuthorizedOfficialFirstName: | ELTON | ||||||||
| AuthorizedOfficialMiddleName: | RAY | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN ASSISTANT | ||||||||
| AuthorizedOfficialTelephone: | 5597867837 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PA-C | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QE0002X | PA18501 | CA | Y | Ambulatory Health Care Facilities | Clinic/Center | Emergency Care |
ID Information
| ID | Type | State | Issuer | Description | 1407999436 | 01 | NPI | OTHER |