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General NPI Number Information
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NPI Number | 1568190064
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Entity Type | Organization
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Legal Business Name | PREMIER CANCER CARE AND INFUSION CENTER
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Dates
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Enumeration Date | 08/11/2022
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Last Update Date | 06/17/2025
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Provider Practice Location Address
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Address Line | 6121 N THESTA ST STE 204
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City | FRESNO
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State | CA
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Zip | 93710-5294
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Country | US
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Telephone | 595-554-2100
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Fax | 559-554-2114
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Provider Business Mailing Address
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Address Line | PO BOX 26897
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City | FRESNO
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State | CA
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Zip | 93729-6897
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Country | US
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Telephone | 559-554-2100
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Fax | 775-747-5005
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. DINA IBRAHIM
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Credential | MD
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Telephone | 559-554-2100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number |
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License Number State |
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