Healthcare Provider Details

I. General information

NPI: 1952841363
Provider Name (Legal Business Name): PREMIER HEALTHCARE OF CALIFORNIA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2017
Last Update Date: 10/28/2020
Certification Date: 10/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 SOUTH ST STE F
REDDING CA
96001-2101
US

IV. Provider business mailing address

3335 PLACER ST SUITE 207
REDDING CA
96001-2364
US

V. Phone/Fax

Practice location:
  • Phone: 530-241-1095
  • Fax:
Mailing address:
  • Phone: 530-241-1095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number51427
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number51427
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number51427
License Number StateCA

VIII. Authorized Official

Name: MS. MONICA LEE GRALIAN
Title or Position: PRESIDENT/OWNER/ PA-C
Credential: PA-C
Phone: 530-941-1017