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General NPI Number Information
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NPI Number | 1205332343
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Entity Type | Organization
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Legal Business Name | PRECISE TELEHEALTH OF CALIFORNIA, A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 04/05/2018
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Last Update Date | 05/26/2022
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Provider Practice Location Address
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Address Line | 4482 MAIN STREET PRIMARY LOCATION
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City | RIVERSIDE
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State | CA
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Zip | 92501-4144
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Country | US
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Telephone | 410-862-0820
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Fax | 884-828-6164
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Provider Business Mailing Address
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Address Line | 22 W PADONIA RD STE C241
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City | TIMONIUM
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State | MD
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Zip | 21093-2237
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Country | US
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Telephone | 203-524-9871
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Fax | 844-828-6164
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Authorized Official
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Title or Position | CEO
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Name | MICHAEL KEROUAC
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Credential |
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Telephone | 203-524-9871
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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