Healthcare Provider Details

I. General information

NPI: 1790057206
Provider Name (Legal Business Name): PREMIER ACO PHYSICIANS NETWORK, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2012
Last Update Date: 01/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4909 LAKEWOOD BLVD SUITE 200
LAKEWOOD CA
90712
US

IV. Provider business mailing address

4909 LAKEWOOD BLVD SUITE 200
LAKEWOOD CA
90712
US

V. Phone/Fax

Practice location:
  • Phone: 562-602-1563
  • Fax: 156-266-3884
Mailing address:
  • Phone: 562-602-1563
  • Fax: 156-266-3884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: CYNTHIA GUZMAN
Title or Position: CEO
Credential: CPA
Phone: 562-602-1563