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>> Emergency Medicine >> Allopathic & Osteopathic Physicians

Registrant NPI Number: 1295780583

Individual Registrant:
Gender: M
Sole Proprietor

Location and contact information for practice:
1 KINGS WAY  AVENAL, CA 93204-9708 US
Tel: 559-386-6042  Fax: --

Contact information for business:
2100 POWELL ST STE 900 EMERYVILLE, CA 94608-1844 US
Tel: 510-851-7423  Fax: 510-879-9120

Registration Information:
NPI: 1295780583
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
N207P00000XAllopathic & Osteopathic Physicians
Emergency Medicine
N207R00000XAllopathic & Osteopathic Physicians
Internal Medicine
Y208M00000XAllopathic & Osteopathic Physicians

Legacy codes, insurance codes and state license numbers:



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