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General NPI Number Information
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NPI Number | 1255125563
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Entity Type | Organization
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Legal Business Name | PREMIUM ALLERGY
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Dates
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Enumeration Date | 04/09/2025
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Last Update Date | 04/22/2025
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Provider Practice Location Address
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Address Line | 2021 HERNDON AVE STE 201
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City | CLOVIS
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State | CA
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Zip | 93611-6317
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Country | US
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Telephone | 559-494-4446
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Fax |
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Provider Business Mailing Address
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Address Line | 2021 HERNDON AVE STE 201
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City | CLOVIS
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State | CA
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Zip | 93611-6317
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Country | US
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Telephone | 559-387-5230
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Fax |
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Authorized Official
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Title or Position | ADMIN
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Name | SONYA LEAL
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Credential |
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Telephone | 559-387-5230
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number |
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License Number State |
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