Basic Information
| Provider Information | |||||||||
| NPI: | 1538722301 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CALIFORNIA EMERGENCY PHYSICIANS MEDICAL GROUP A PROFESSIONAL CORP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1601 CUMMINS DR STE D | ||||||||
| Address2: | |||||||||
| City: | MODESTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953586411 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5103502600 | ||||||||
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| Practice Location | |||||||||
| Address1: | 201 HARTNELL AVE | ||||||||
| Address2: | |||||||||
| City: | REDDING | ||||||||
| State: | CA | ||||||||
| PostalCode: | 960021843 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5302222273 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2019 | ||||||||
| LastUpdateDate: | 03/30/2020 | ||||||||
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| AuthorizedOfficialLastName: | BIRDSALL | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
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| AuthorizedOfficialTitleorPosition: | C.O.O | ||||||||
| AuthorizedOfficialTelephone: | 5103502600 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D | ||||||||
| NPICertificationDate: | 03/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.