Basic Information
| Provider Information | |||||||||
| NPI: | 1639698475 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FOUNTAIN VALLEY EMERGENCY PHYSICIANS, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 825 EMERALD BAY | ||||||||
| Address2: | |||||||||
| City: | LAGUNA BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926511228 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5624680227 | ||||||||
| FaxNumber: | 5629245830 | ||||||||
| Practice Location | |||||||||
| Address1: | 17100 EUCLID ST | ||||||||
| Address2: | |||||||||
| City: | FOUNTAIN VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927084004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7149667200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2017 | ||||||||
| LastUpdateDate: | 09/13/2017 | ||||||||
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| AuthorizedOfficialLastName: | KORBER | ||||||||
| AuthorizedOfficialFirstName: | TIMOTHY | ||||||||
| AuthorizedOfficialMiddleName: | E. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9494223812 | ||||||||
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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 | 207P00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.