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Organization
MC IBANEZ MEDICAL CORPORATION
Active
Organization
MC IBANEZ MEDICAL CORPORATION
Active
Other names
PRIMELIFE MEDICAL GROUP, INC.
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CAESAR LOCSIN IBANEZ (CEO)
(916) 681-5000
Entity
Organization
Contact information
Practice address
8100 TIMBERLAKE WAY, SUITE C, SACRAMENTO, CA 95823-5409
(916) 681-5000
(916) 681-5887
Mailing address
8100 TIMBERLAKE WAY, SUITE C, SACRAMENTO, CA 95823-5409
(916) 681-5000
(916) 681-5887
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
A64505
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A645050
—
CA
Enumeration date
05/22/2006
Last updated
05/21/2012
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