Provider Demographics
NPI:1548211758
Name:JJ&R EMERGENCY MEDICAL GROUP OF CALIFORNIA, INC.
Entity Type:Organization
Organization Name:JJ&R EMERGENCY MEDICAL GROUP OF CALIFORNIA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:B
Authorized Official - Last Name:STAUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-301-2030
Mailing Address - Street 1:1700 EAST WALNUT AVENUE
Mailing Address - Street 2:#250
Mailing Address - City:EL SAGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245-2605
Mailing Address - Country:US
Mailing Address - Phone:310-301-2030
Mailing Address - Fax:310-306-5247
Practice Address - Street 1:1025 S ANAHEIM BLVD
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-5806
Practice Address - Country:US
Practice Address - Phone:714-533-6220
Practice Address - Fax:714-563-2859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG28196207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0056141Medicaid
CAGR0056141Medicaid