Healthcare Provider Details

I. General information

NPI: 1316079106
Provider Name (Legal Business Name): PREMIER NEPHROLOGY MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 07/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 S GRAND AVE STE. 800
LOS ANGELES CA
90015-3048
US

IV. Provider business mailing address

1400 S GRAND AVE STE. 800
LOS ANGELES CA
90015-3048
US

V. Phone/Fax

Practice location:
  • Phone: 213-748-1414
  • Fax: 213-749-4021
Mailing address:
  • Phone: 213-748-1414
  • Fax: 213-749-4021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BRUCE A GREENFIELD
Title or Position: PRESIDENT
Credential: MD
Phone: 213-742-1414