# PRIMA MEDICAL FOUNDATION

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

## Provider details

- **NPI number:** 1902244528
- **Legal business name:** PRIMA MEDICAL FOUNDATION
- **Authorized official:** DENNIS MONDRAGON (COO)
- **Authorized official phone:** (415) 884-1840

## Contact information

- **Practice address:** 652 PETALUMA AVE, SUITE H, SEBASTOPOL, CA 95472-4256
- **Practice address phone:** (707) 823-7616
- **Practice address fax:** (707) 823-2803
- **Mailing address:** 4 HAMILTON LNDG, SUITE 100, NOVATO, CA 94949-8256
- **Mailing address phone:** (415) 884-1840
- **Mailing address fax:** (415) 883-7127

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 06/05/2013
- **Last updated:** 06/05/2013