Healthcare Provider Details

I. General information

NPI: 1841530037
Provider Name (Legal Business Name): PREMISE HEALTH OF CALIFORNIA MEDICAL, P.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2013
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

573 SANTA RITA AVE
MODESTO CA
95354-3756
US

IV. Provider business mailing address

5500 MARYLAND WAY
BRENTWOOD TN
37027-7048
US

V. Phone/Fax

Practice location:
  • Phone: 209-341-3636
  • Fax: 209-341-8329
Mailing address:
  • Phone: 209-341-3636
  • Fax: 209-341-8329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JON LEIZMAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 615-394-2341