Provider Demographics
NPI:1265926000
Name:QUEST PREMIER MEDICAL GROUP A PROFESSIONAL MEDICAL CORPORATION
Entity type:Organization
Organization Name:QUEST PREMIER MEDICAL GROUP A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:J
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-278-9046
Mailing Address - Street 1:1630 E GONZALES RD
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93036-3700
Mailing Address - Country:US
Mailing Address - Phone:805-278-9046
Mailing Address - Fax:805-278-9047
Practice Address - Street 1:1630 E GONZALES RD
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-3700
Practice Address - Country:US
Practice Address - Phone:805-278-9046
Practice Address - Fax:805-278-9047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-15
Last Update Date:2018-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA548562207QB0002X, 2084B0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084B0002XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyObesity MedicineGroup - Multi-Specialty
No207QB0002XAllopathic & Osteopathic PhysiciansFamily MedicineObesity MedicineGroup - Multi-Specialty