# PRIMA MEDICAL GROUP-TERRA LINDA

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

## Provider details

- **NPI number:** 1730463258
- **Legal business name:** PRIMA MEDICAL FOUNDATION
- **Authorized official:** MR. JOEL A CRISTE (CEO)
- **Authorized official phone:** (415) 884-1840

## Contact information

- **Practice address:** 4000 CIVIC CENTER DRIVE, SUITE 200B, SAN RAFAEL, CA 94903
- **Practice address phone:** (415) 492-3333
- **Practice address fax:** (415) 492-3425
- **Mailing address:** 4 HAMILTON LANDING, SUITE 100, NOVATO, CA 94949
- **Mailing address phone:** (415) 884-1840
- **Mailing address fax:** (415) 884-3510

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | G73451 | CA | Yes |
| 261QM1300X | Multi-Specialty Clinic/Center | G55637 | CA | — |

## Other

- **Enumeration date:** 10/03/2011
- **Last updated:** 08/14/2012