# PRIMA MEDICAL FOUNDATION

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** PRIMA MEDICAL FOUNDATION
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1548258106
- **Legal business name:** PRIMA MEDICAL FOUNDATION
- **Authorized official:** JOANNA RUBEL (SR. DIRECTOR OF PRACTICE OPERATIONS)
- **Authorized official phone:** (415) 842-5103

## Contact information

- **Practice address:** 1260 S ELISEO DR, FLOOR 2, GREENBRAE, CA 94904-2009
- **Practice address phone:** (415) 461-7800
- **Practice address fax:** (415) 924-1375
- **Mailing address:** 9 COMMERCIAL BLVD, SUITE 200, NOVATO, CA 94949-6118
- **Mailing address phone:** (415) 842-5000

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RI0011X | Interventional Cardiology Physician | G88295 | CA | — |
| 207RP1001X | Pulmonary Disease Physician | G45217 | CA | — |
| 208D00000X | General Practice Physician | A72388 | CA | Yes |
| 208D00000X | General Practice Physician | — | — | — |

## Other

- **Enumeration date:** 10/07/2005
- **Last updated:** 08/13/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | ZZZ03538Z | MEDICARE | CA |