Provider Demographics
NPI:1316364474
Name:CALIFORNIA EMERGENCY PHYSICIANS MEDICAL GROUP A PROFESSIONAL CORP
Entity Type:Organization
Organization Name:CALIFORNIA EMERGENCY PHYSICIANS MEDICAL GROUP A PROFESSIONAL CORP
Other - Org Name:VITUITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:BIRDSALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-350-2600
Mailing Address - Street 1:1601 CUMMINS DR STE D
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95358-6411
Mailing Address - Country:US
Mailing Address - Phone:510-851-7411
Mailing Address - Fax:
Practice Address - Street 1:1359 PINE ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-4807
Practice Address - Country:US
Practice Address - Phone:415-673-8405
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-26
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty