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General NPI Number Information
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NPI Number | 1689905564
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Entity Type | Organization
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Legal Business Name | PREMIER HEALTH SERVICES INC
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Dates
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Enumeration Date | 01/17/2010
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Last Update Date | 01/17/2010
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Provider Practice Location Address
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Address Line | 7136 HASKELL AVE STE 125
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City | VAN NUYS
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State | CA
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Zip | 91406-4112
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Country | US
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Telephone | 818-302-3402
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Fax | 818-647-0359
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Provider Business Mailing Address
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Address Line | 13659 VICTORY BLVD STE 690
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City | VAN NUYS
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State | CA
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Zip | 91401-1735
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Country | US
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Telephone | 818-302-3402
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Fax | 818-647-0359
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Authorized Official
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Title or Position | PRESIDENT
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Name | ROBERT K UEDA
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Credential | M.D.
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Telephone | 818-302-3402
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | A94410
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License Number State | CA
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