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Organization
MANTECA EMERGENCY PHYSICIANS, A MEDICAL CORPORATION
Active
Organization
MANTECA EMERGENCY PHYSICIANS, A MEDICAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY KONDAS (OFFICER)
(973) 251-1132
Entity
Organization
Contact information
Practice address
1205 E NORTH ST, MANTECA, CA 95336-4932
(469) 401-2386
Mailing address
5565 CENTERVIEW DR STE 107, RALEIGH, NC 27606-3563
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
CA
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
201461781
CALIFORNIA BLUE CROSS
CA
Enumeration date
11/13/2006
Last updated
05/14/2021
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