Provider Demographics
NPI:1659056984
Name:PREMIER CLINIC PLLC
Entity Type:Organization
Organization Name:PREMIER CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL PROVIDER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KARINA
Authorized Official - Middle Name:YVETTE
Authorized Official - Last Name:MENDOZA
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:915-892-1531
Mailing Address - Street 1:11351 JAMES WATT DR BLDG C-300
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-6627
Mailing Address - Country:US
Mailing Address - Phone:915-320-7707
Mailing Address - Fax:949-655-8769
Practice Address - Street 1:11351 JAMES WATT DR BLDG C-300
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-6627
Practice Address - Country:US
Practice Address - Phone:915-320-7707
Practice Address - Fax:949-655-8769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-15
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty