Provider Demographics
NPI:1750454260
Name:EMPIRE PHYSICIANS MEDICAL GROUP
Entity Type:Organization
Organization Name:EMPIRE PHYSICIANS MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:
Authorized Official - Last Name:SONNENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MHA
Authorized Official - Phone:760-770-8678
Mailing Address - Street 1:34160 GATEWAY DR STE 100
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-0852
Mailing Address - Country:US
Mailing Address - Phone:760-770-8678
Mailing Address - Fax:760-770-7609
Practice Address - Street 1:34160 GATEWAY DR STE 100
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-0852
Practice Address - Country:US
Practice Address - Phone:760-770-8678
Practice Address - Fax:760-770-7609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAFNP28851302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization