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General NPI Number Information
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NPI Number | 1962867754
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Entity Type | Organization
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Legal Business Name | PREMIER HEALTH PARTNERS
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Dates
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Enumeration Date | 12/21/2015
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Last Update Date | 12/21/2015
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Provider Practice Location Address
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Address Line | 15248 11TH ST
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City | VICTORVILLE
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State | CA
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Zip | 92395-3704
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Country | US
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Telephone | 760-843-6099
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Fax |
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Provider Business Mailing Address
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Address Line | 15248 11TH ST
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City | VICTORVILLE
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State | CA
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Zip | 92395-3704
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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 | PRESIDENT
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Name | DR. ANTHONY CARDILLO
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Credential | M.D.
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Telephone | 310-488-2830
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | A82516
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License Number State | CA
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