Healthcare Provider Details

I. General information

NPI: 1609077635
Provider Name (Legal Business Name): PREMIER PHYSICIAN ALLIANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 02/06/2024
Certification Date: 02/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5001 CALIFORNIA AVE STE 202
BAKERSFIELD CA
93309-1692
US

IV. Provider business mailing address

PO BOX 2103
BAKERSFIELD CA
93303-2103
US

V. Phone/Fax

Practice location:
  • Phone: 661-809-2005
  • Fax: 661-381-7546
Mailing address:
  • Phone: 661-809-2005
  • Fax: 661-381-7545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State

VIII. Authorized Official

Name: DR. DONALD EVERETT CORNFORTH
Title or Position: PRESIDENT
Credential: M.D.
Phone: 661-809-2005