Healthcare Provider Details

I. General information

NPI: 1477275840
Provider Name (Legal Business Name): PREMIER ADVANTAGE HEALTH CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2022
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8631 W 3RD ST STE 715E-B
LOS ANGELES CA
90048-5901
US

IV. Provider business mailing address

19500 NORMANDIE AVE
TORRANCE CA
90502-1108
US

V. Phone/Fax

Practice location:
  • Phone: 866-365-2525
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: FINLY ZACHARIAH
Title or Position: MEDICAL DIRECTOR
Credential:
Phone: 310-623-5659