Healthcare Provider Details

I. General information

NPI: 1225376817
Provider Name (Legal Business Name): PREMIER PHYSICIAN SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2013
Last Update Date: 08/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4445 EASTGATE MALL SUITE 200
SAN DIEGO CA
92121-1979
US

IV. Provider business mailing address

4445 EASTGATE MALL SUITE 200
SAN DIEGO CA
92121-1979
US

V. Phone/Fax

Practice location:
  • Phone: 855-652-4946
  • Fax:
Mailing address:
  • Phone: 855-652-4946
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MARIA DANILYCHEV
Title or Position: PRESIDENT
Credential: M.D.
Phone: 858-775-3587