Healthcare Provider Details

I. General information

NPI: 1285689117
Provider Name (Legal Business Name): PREMIER MEDICAL DOCTORS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 04/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 W E ST
TEHACHAPI CA
93561-1607
US

IV. Provider business mailing address

12523 LIMONITE AVE SUITE 440-235
MIRA LOMA CA
91752-3665
US

V. Phone/Fax

Practice location:
  • Phone: 714-717-8285
  • Fax:
Mailing address:
  • Phone: 714-717-8285
  • Fax: 951-685-3381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL SANTILLANES
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 714-717-8285