Provider Demographics
NPI:1407999436
Name:CALIFORNIA EMERGENCY PHYSICIAN
Entity Type:Organization
Organization Name:CALIFORNIA EMERGENCY PHYSICIAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:ELTON
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:TRIPP
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:559-786-7837
Mailing Address - Street 1:282 HEMMINGWAY CT
Mailing Address - Street 2:
Mailing Address - City:TULARE
Mailing Address - State:CA
Mailing Address - Zip Code:93274-6046
Mailing Address - Country:US
Mailing Address - Phone:559-686-7881
Mailing Address - Fax:
Practice Address - Street 1:869 N CHERRY ST
Practice Address - Street 2:
Practice Address - City:TULARE
Practice Address - State:CA
Practice Address - Zip Code:93274-2207
Practice Address - Country:US
Practice Address - Phone:559-688-0821
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA18501261QE0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
1407999436OtherNPI