Healthcare Provider Details

I. General information

NPI: 1962867754
Provider Name (Legal Business Name): PREMIER HEALTH PARTNERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2015
Last Update Date: 12/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15248 11TH ST
VICTORVILLE CA
92395-3704
US

IV. Provider business mailing address

15248 11TH ST
VICTORVILLE CA
92395-3704
US

V. Phone/Fax

Practice location:
  • Phone: 760-843-6099
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA82516
License Number StateCA

VIII. Authorized Official

Name: DR. ANTHONY CARDILLO
Title or Position: PRESIDENT
Credential: M.D.
Phone: 310-488-2830