Provider Demographics
NPI:1255635306
Name:PREMISE HEALTH OF CALIFORNIA MEDICAL, P.C
Entity type:Organization
Organization Name:PREMISE HEALTH OF CALIFORNIA MEDICAL, P.C
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:
Authorized Official - Last Name:LEIZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:216-479-9063
Mailing Address - Street 1:5500 MARYLAND WAY
Mailing Address - Street 2:ATTN: RCM
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-4948
Mailing Address - Country:US
Mailing Address - Phone:888-830-4255
Mailing Address - Fax:615-296-0151
Practice Address - Street 1:3000 HANOVER ST
Practice Address - Street 2:BLDG 20, LEVEL D
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-1112
Practice Address - Country:US
Practice Address - Phone:650-319-1080
Practice Address - Fax:650-319-0889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-04
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care