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General NPI Number Information
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NPI Number | 1821893983
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Entity Type | Organization
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Legal Business Name | PREMIER CARE PROVIDERS, INC
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Dates
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Enumeration Date | 02/13/2025
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Last Update Date | 02/13/2025
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Provider Practice Location Address
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Address Line | 7219 VAN NUYS BLVD
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City | VAN NUYS
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State | CA
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Zip | 91405-2256
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Country | US
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Telephone | 818-855-1400
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Fax | 818-846-8559
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Provider Business Mailing Address
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Address Line | 7219 VAN NUYS BLVD
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City | VAN NUYS
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State | CA
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Zip | 91405-2256
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Country | US
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Telephone | 818-855-1400
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTICIONER
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Name | BRIAN EARL BRISTOL
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Credential | NURSE PRACTITIONER
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Telephone | 310-795-7528
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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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 | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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