Organization
CEP AMERICA - CALIFORNIA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THEOPHILE KOURY MD (COO)
(510) 350-2600
Entity
Organization
Contact information
Practice address
654 CAMINO DE LOS MARES, SAN CLEMENTE, CA 92673-2827
(949) 496-1122
Mailing address
2100 POWELL ST, STE 900, EMERYVILLE, CA 94608-1826
(510) 350-2600
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR001302C
—
CA
Enumeration date
11/15/2006
Last updated
05/11/2016
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