Provider Demographics
NPI:1255856555
Name:CALIFORNIA PHYSICIAN NETWORK LLC
Entity Type:Organization
Organization Name:CALIFORNIA PHYSICIAN NETWORK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:DENNISE
Authorized Official - Middle Name:
Authorized Official - Last Name:MEJIA
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:818-339-3113
Mailing Address - Street 1:7657 WINNETKA AVE # 712
Mailing Address - Street 2:
Mailing Address - City:WINNETKA
Mailing Address - State:CA
Mailing Address - Zip Code:91306-2677
Mailing Address - Country:US
Mailing Address - Phone:818-912-8127
Mailing Address - Fax:818-478-2305
Practice Address - Street 1:7657 WINNETKA #712
Practice Address - Street 2:
Practice Address - City:WINNETKA
Practice Address - State:CA
Practice Address - Zip Code:91306
Practice Address - Country:US
Practice Address - Phone:818-436-0416
Practice Address - Fax:818-478-2305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)