Healthcare Provider Details

I. General information

NPI: 1205332343
Provider Name (Legal Business Name): PRECISE TELEHEALTH OF CALIFORNIA, A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2018
Last Update Date: 05/26/2022
Certification Date: 05/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4482 MAIN STREET PRIMARY LOCATION
RIVERSIDE CA
92501-4144
US

IV. Provider business mailing address

22 W PADONIA RD STE C241
TIMONIUM MD
21093-2237
US

V. Phone/Fax

Practice location:
  • Phone: 410-862-0820
  • Fax: 884-828-6164
Mailing address:
  • Phone: 203-524-9871
  • Fax: 844-828-6164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL KEROUAC
Title or Position: CEO
Credential:
Phone: 203-524-9871