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Organization
PREMIER EMERGENCY PHYSICIANS OF CALIFORNIA MEDICAL GROUP PC
Active
Organization
PREMIER EMERGENCY PHYSICIANS OF CALIFORNIA MEDICAL GROUP PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY KONDAS (OFFICER)
(973) 251-1132
Entity
Organization
Contact information
Practice address
1401 BAILEY AVE, NEEDLES, CA 92363-3103
(760) 326-7194
Mailing address
PO BOX 7388, PHILADELPHIA, PA 19101-7388
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1578512711
—
CA
05
—
GR0094164
—
CA
01
—
ZZZ65417Z
BLUE SHIELD OF CALIFORNIA
CA
Enumeration date
05/06/2006
Last updated
04/09/2021
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