Healthcare Provider Details

I. General information

NPI: 1528202363
Provider Name (Legal Business Name): PREMIER CARDIOLOGY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2009
Last Update Date: 03/18/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 OLD NEWPORT BLVD STE 201
NEWPORT BEACH CA
92663-4289
US

IV. Provider business mailing address

401 OLD NEWPORT BLVD STE 201
NEWPORT BEACH CA
92663-4289
US

V. Phone/Fax

Practice location:
  • Phone: 949-478-7373
  • Fax: 949-650-2898
Mailing address:
  • Phone: 949-478-7373
  • Fax: 949-650-2898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. GIA ALLEN
Title or Position: BILLING SUPERVISOR
Credential:
Phone: 949-478-7373