Provider Demographics
NPI:1568946564
Name:PREMIER HEALTHCARE OF CALIFORNIA INC
Entity Type:Organization
Organization Name:PREMIER HEALTHCARE OF CALIFORNIA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PA/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRALIAN
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:530-941-1017
Mailing Address - Street 1:3335 PLACER ST STE 207
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-2364
Mailing Address - Country:US
Mailing Address - Phone:530-941-1017
Mailing Address - Fax:530-241-1095
Practice Address - Street 1:448 REDCLIFF DR STE 120
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-0159
Practice Address - Country:US
Practice Address - Phone:530-941-1017
Practice Address - Fax:530-241-1095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-17
Last Update Date:2018-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPENDINGMedicaid