Premier Emergency Physicians of California Medical Group PC

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

Legal business name

PREMIER EMERGENCY PHYSICIANS OF CALIFORNIA MEDICAL GROUP PC

Practice address

768 Mountain Ranch Rd
San Andreas, CA 95249-9707

Phone

(209) 754-3521

NPI assigned

May 17, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kathy Kondas

Title

Officer

Phone

(973) 251-1132

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1305590400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1617926400000",
    "number": "1164715645",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3916 STATE ST",
            "address_2": "#300",
            "city": "SANTA BARBARA",
            "state": "CA",
            "postal_code": "931055602",
            "fax_number": "805-564-5087"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "768 MOUNTAIN RANCH RD",
            "city": "SAN ANDREAS",
            "state": "CA",
            "postal_code": "952499707",
            "telephone_number": "209-754-3521"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER EMERGENCY PHYSICIANS OF CALIFORNIA MEDICAL GROUP PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-17",
        "last_updated": "2021-04-09",
        "certification_date": "2021-04-09",
        "status": "A",
        "authorized_official_last_name": "KONDAS",
        "authorized_official_first_name": "KATHY",
        "authorized_official_title_or_position": "OFFICER",
        "authorized_official_telephone_number": "973-251-1132"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gabriel R Pettersen, MD
• Chris Pettinichio
• Thanh Duc Pham, D.D.S.
• Miguel Picasso
• Tandis Kaye Pourbastani
• Danielle Lorraine Pullin
• Danielle Pyevich, MD
• Radiologica Inc.
• Richard Radliff
• Kimberley Dawn Rainier, B.S.

• Emergency Medicine Physician in San Andreas, CA
• Providers in San Andreas, CA by specialty
• Emergency Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.