Organization
PREMIUM HEALTH MEDICAL GROUP
Active
Organization
PREMIUM HEALTH MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RAMIN MONTAZERI (CEO)
(949) 463-9876
Entity
Organization
Contact information
Practice address
1820 E GARRY AVE STE 116, SANTA ANA, CA 92705-5804
(949) 463-9876
Mailing address
1820 E GARRY AVE STE 103, SANTA ANA, CA 92705-5804
(949) 463-9876
Taxonomy
Speciality
Code
Description
License number
State
2083X0100X
Occupational Medicine Physician
Primary
—
—
208D00000X
General Practice Physician
—
—
261QP2300X
Primary Care Clinic/Center
—
—
Other
Enumeration date
05/13/2022
Last updated
06/30/2022
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