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General NPI Number Information
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NPI Number | 1245061340
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Entity Type | Organization
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Legal Business Name | PREMIUM PSYCHIATRIC CARE NURSING -PC
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Dates
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Enumeration Date | 08/10/2024
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Last Update Date | 04/15/2025
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Provider Practice Location Address
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Address Line | 4695 CHABOT DR STE 200
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City | PLEASANTON
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State | CA
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Zip | 94588-2756
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Country | US
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Telephone | 925-261-7728
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Fax | 925-420-8625
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Provider Business Mailing Address
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Address Line | 4695 CHABOT DR STE 200
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City | PLEASANTON
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State | CA
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Zip | 94588-2756
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Country | US
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Telephone | 925-261-7728
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Fax | 925-420-8625
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Authorized Official
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Title or Position | CEO
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Name | ABIBAT AJIBOYE
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Credential |
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Telephone | 925-261-7728
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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