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General NPI Number Information
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NPI Number | 1689166241
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Entity Type | Organization
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Legal Business Name | PREMIER SENIOR MEDICAL GROUP OF SAN BERNARDINO, INC.
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Dates
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Enumeration Date | 05/30/2018
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Last Update Date | 05/30/2018
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Provider Practice Location Address
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Address Line | 284 E HIGHLAND AVE
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City | SAN BERNARDINO
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State | CA
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Zip | 92404-3706
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Country | US
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Telephone | 909-883-1098
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Fax |
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Provider Business Mailing Address
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Address Line | 31938 TEMECULA PKWY STE A237
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City | TEMECULA
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State | CA
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Zip | 92592-6810
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Country | US
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Telephone | 714-414-3065
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DAVID JOHNSON
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Credential | MD
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Telephone | 207-217-5451
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number |
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License Number State |
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