Healthcare Provider Details

I. General information

NPI: 1730112426
Provider Name (Legal Business Name): PREMIER FAMILY MEDICINE ASSOCIATES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 02/25/2026
Certification Date: 02/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2140 GRAND AVE STE 125
CHINO HILLS CA
91709-6802
US

IV. Provider business mailing address

2140 GRAND AVE STE 125
CHINO HILLS CA
91709-6802
US

V. Phone/Fax

Practice location:
  • Phone: 909-630-7875
  • Fax: 909-469-2107
Mailing address:
  • Phone: 909-630-7875
  • Fax: 909-469-2107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number550000
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateCA

VIII. Authorized Official

Name: TAMARA J WARNER
Title or Position: ADMIN COORDINATOR
Credential:
Phone: 909-865-9501