Healthcare Provider Details

I. General information

NPI: 1174635361
Provider Name (Legal Business Name): PREMIER DIAGNOSTICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1851 HOLSER WALK SUITE 210
OXNARD CA
93036-2626
US

IV. Provider business mailing address

1851 HOLSER WALK SUITE 210
OXNARD CA
93036-2626
US

V. Phone/Fax

Practice location:
  • Phone: 805-485-2633
  • Fax: 805-485-6650
Mailing address:
  • Phone: 805-485-2633
  • Fax: 805-485-6650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JERRY CURTIS HARRIS
Title or Position: ADMINISTRATIVE DIRECTOR
Credential: RCP RRT
Phone: 805-485-2633