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General NPI Number Information
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NPI Number | 1497919112
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Entity Type | Organization
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Legal Business Name | PREMIER CARE IPA
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Dates
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Enumeration Date | 07/11/2008
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Last Update Date | 07/11/2008
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Provider Practice Location Address
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Address Line | 1865 ALUM ROCK AVE STE A
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City | SAN JOSE
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State | CA
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Zip | 95116-1396
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Country | US
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Telephone | 408-258-3229
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Fax | 408-258-3422
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Provider Business Mailing Address
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Address Line | 1865 ALUM ROCK AVE STE A
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City | SAN JOSE
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State | CA
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Zip | 95116-1396
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHYSICAL MEDICINE & REHAB
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Name | DR. TUYEN NGO
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Credential | MD
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Telephone | 408-258-3229
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number |
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License Number State |
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