Healthcare Provider Details

I. General information

NPI: 1407304439
Provider Name (Legal Business Name): PREMIER ORTHOPAEDIC TRAUMA SPECIALISTS, PMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2016
Last Update Date: 02/17/2025
Certification Date: 02/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 E ARTESIA ST STE 255
POMONA CA
91767-2921
US

IV. Provider business mailing address

160 E ARTESIA ST STE 255
POMONA CA
91767-2921
US

V. Phone/Fax

Practice location:
  • Phone: 909-596-4346
  • Fax:
Mailing address:
  • Phone: 909-596-4346
  • Fax: 909-596-4344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: HRAYR G BASMAJIAN
Title or Position: CEO
Credential:
Phone: 909-596-4346