Healthcare Provider Details

I. General information

NPI: 1962827907
Provider Name (Legal Business Name): PREMIER SCREENING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2014
Last Update Date: 02/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 N LAKE AVE SUITE 800
PASADENA CA
91101-1849
US

IV. Provider business mailing address

155 N LAKE AVE SUITE 800
PASADENA CA
91101-1849
US

V. Phone/Fax

Practice location:
  • Phone: 626-236-3694
  • Fax:
Mailing address:
  • Phone: 626-236-3694
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: SUZANNE MARY MULLEN
Title or Position: MANAGER
Credential:
Phone: 626-236-3694