Provider Demographics
NPI:1407304439
Name:PREMIER ORTHOPAEDIC TRAUMA SPECIALISTS, PMC
Entity Type:Organization
Organization Name:PREMIER ORTHOPAEDIC TRAUMA SPECIALISTS, PMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:HRAYR
Authorized Official - Middle Name:G
Authorized Official - Last Name:BASMAJIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-596-4346
Mailing Address - Street 1:160 E ARTESIA ST STE 255
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-2921
Mailing Address - Country:US
Mailing Address - Phone:909-596-4346
Mailing Address - Fax:909-596-4344
Practice Address - Street 1:160 E ARTESIA ST STE 255
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-2921
Practice Address - Country:US
Practice Address - Phone:909-596-4346
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-20
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty