Basic Information
Provider Information
NPI: 1427482967
EntityType: 2
ReplacementNPI:  
OrganizationName: CEP AMERICA
LastName:  
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Credential:  
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Mailing Information
Address1: 18846 SANTA BARBARA ST
Address2:  
City: FOUNTAIN VALLEY
State: CA
PostalCode: 927086311
CountryCode: US
TelephoneNumber: 7144016385
FaxNumber:  
Practice Location
Address1: 400 N PEPPER AVE
Address2:  
City: COLTON
State: CA
PostalCode: 923241801
CountryCode: US
TelephoneNumber: 9095801000
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/31/2013
LastUpdateDate: 08/31/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: MARTIN
AuthorizedOfficialFirstName: SCOTT
AuthorizedOfficialMiddleName: LUIS
AuthorizedOfficialTitleorPosition: PHYSICIAN ASSISTANT
AuthorizedOfficialTelephone: 7144016385
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: MR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: MSPA
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
282N00000X  Y HospitalsGeneral Acute Care Hospital 

No ID Information.


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