Provider Demographics
NPI:1538448964
Name:PREMIER HEALTH PLAN SERVICES, INC.
Entity type:Organization
Organization Name:PREMIER HEALTH PLAN SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:GUZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-602-1563
Mailing Address - Street 1:4909 LAKEWOOD BLVD
Mailing Address - Street 2:#200
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90712-2405
Mailing Address - Country:US
Mailing Address - Phone:562-602-1563
Mailing Address - Fax:562-529-8490
Practice Address - Street 1:4909 LAKEWOOD BLVD
Practice Address - Street 2:#200
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712-2405
Practice Address - Country:US
Practice Address - Phone:562-602-1563
Practice Address - Fax:562-529-8490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-16
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA933 0473302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization