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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
465 W PUTNAM AVE, PORTERVILLE, CA 93257-3320
(559) 784-8886
(559) 791-4802
Mailing address
PO BOX 37655, PHILADELPHIA, PA 19101-0655
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1891994174
—
CA
01
—
DH0325
RAILROAD
CA
05
—
GR0094164
—
CA
01
—
ZZZ62867Z
BLUE SHIELD OF CALIFORNIA
CA
Enumeration date
07/16/2007
Last updated
04/09/2021
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