Organization
PREMIUM EXTREMITY CARE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALI HEIDARI DO (OWNER/CEO)
(909) 982-1002
Entity
Organization
Contact information
Practice address
843 E FOOTHILL BLVD, UPLAND, CA 91786-4034
(909) 982-1002
Mailing address
843 E FOOTHILL BLVD, UPLAND, CA 91786-4034
(909) 982-1002
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
—
—
Other
Enumeration date
08/09/2022
Last updated
08/09/2022
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