Provider Demographics
NPI:1033357736
Name:CALIFORNIA HEALTHFIRST PHYSICIANS
Entity Type:Organization
Organization Name:CALIFORNIA HEALTHFIRST PHYSICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:PERKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-335-7171
Mailing Address - Street 1:PO BOX 10968
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92423-0968
Mailing Address - Country:US
Mailing Address - Phone:909-335-7171
Mailing Address - Fax:909-335-7140
Practice Address - Street 1:5051 VERDUGO WAY
Practice Address - Street 2:SUITE 110
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93012-8680
Practice Address - Country:US
Practice Address - Phone:805-445-7010
Practice Address - Fax:805-484-3610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-03
Last Update Date:2009-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ55868YOtherBS/TRIWEST
CA1033357736Medicaid
CAZZZ55868YOtherBS/TRIWEST
CADO2438Medicare PIN
CAW21724Medicare PIN