Provider Demographics
NPI:1417622374
Name:STATE OF CALIFORNIA EMERGENCY MEDICAL SERVICES AUTHORITY
Entity Type:Organization
Organization Name:STATE OF CALIFORNIA EMERGENCY MEDICAL SERVICES AUTHORITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNCAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-431-3716
Mailing Address - Street 1:10901 GOLD CENTER DRIVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670
Mailing Address - Country:US
Mailing Address - Phone:916-322-4336
Mailing Address - Fax:
Practice Address - Street 1:10901 GOLD CENTER DRIVE
Practice Address - Street 2:SUITE 400
Practice Address - City:RANCHO CORDOVA
Practice Address - State:CA
Practice Address - Zip Code:95670
Practice Address - Country:US
Practice Address - Phone:916-322-4336
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-12
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
No261QM1000XAmbulatory Health Care FacilitiesClinic/CenterMigrant Health
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy