MEDICARE: PREMIER FAMILY MEDICINE ASSOCIATES, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician
2	261QH0100X	Health Service Clinic/Center

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	CG8716	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	00127095	OTHER	CA	POMONA BUSINESS LICENSE
5	ZZZ57392Z	OTHER		BLUE SHIELD OF CALIFORNIA
6	05D0931230	OTHER	CA	CLIA

General Provider Information

NPI Number	:	1912907114
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER FAMILY MEDICINE ASSOCIATES, INC

Provider Business Mailing Address
First Line	:	1770 N ORANGE GROVE AVE STE 101
Second Line	:
City	:	POMONA
State	:	CA
Zip	:	91767-3027
Country	:	US
Telephone Number	:	909-469-9494
Fax Number	:	909-469-2120

Provider Business Practice Location Address
First Line	:	1770 N ORANGE GROVE AVE STE 101
Second Line	:
City	:	POMONA
State	:	CA
Zip	:	91767-3027
Country	:	US
Telephone Number	:	909-469-9494
Fax Number	:	909-469-2120

Authorized Official
Title or Position	:	ADMIN COORDINATOR
Name	:	TAMARA J WARNER
Credential	:
Telephone Number	:	909-865-9501

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	02/25/2026

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Directions to “PREMIER FAMILY MEDICINE ASSOCIATES, INC ” Practice Location

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