Healthcare Provider Details

I. General information

NPI: 1255125563
Provider Name (Legal Business Name): PREMIUM ALLERGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2025
Last Update Date: 04/22/2025
Certification Date: 04/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 HERNDON AVE STE 201
CLOVIS CA
93611-6317
US

IV. Provider business mailing address

2021 HERNDON AVE STE 201
CLOVIS CA
93611-6317
US

V. Phone/Fax

Practice location:
  • Phone: 559-494-4446
  • Fax:
Mailing address:
  • Phone: 559-387-5230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State

VIII. Authorized Official

Name: SONYA LEAL
Title or Position: ADMIN
Credential:
Phone: 559-387-5230