Healthcare Provider Details

I. General information

NPI: 1740051978
Provider Name (Legal Business Name): PREMIER CANCER CARE AND INFUSION CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2024
Last Update Date: 06/22/2025
Certification Date: 06/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6121 N THESTA ST STE 204
FRESNO CA
93710-5294
US

IV. Provider business mailing address

PO BOX 26897
FRESNO CA
93729-6897
US

V. Phone/Fax

Practice location:
  • Phone: 559-554-2100
  • Fax: 559-554-2114
Mailing address:
  • Phone: 877-747-5050
  • Fax: 775-747-5005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: DINA IBRAHIM
Title or Position: CEO
Credential: MD
Phone: 559-554-2100