Provider Demographics
NPI:1497511208
Name:PREMIUM ALLERGY
Entity Type:Organization
Organization Name:PREMIUM ALLERGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:SABRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-494-4446
Mailing Address - Street 1:2021 HERNDON AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-6317
Mailing Address - Country:US
Mailing Address - Phone:559-387-5230
Mailing Address - Fax:
Practice Address - Street 1:7471 N FRESNO ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2457
Practice Address - Country:US
Practice Address - Phone:559-494-4446
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PREMIUM ALLERGY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-02-28
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & ImmunologyGroup - Multi-Specialty
No2080P0201XAllopathic & Osteopathic PhysiciansPediatricsPediatric Allergy/ImmunologyGroup - Multi-Specialty