Organization
PRIMO MEDICAL SPA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VINCENT JOSEPH DONATO D.C (OWNER)
(310) 621-4951
Entity
Organization
Contact information
Practice address
230 N MARYLAND AVE STE 206A, GLENDALE, CA 91206-4282
(310) 621-4951
Mailing address
230 N MARYLAND AVE STE 206A, GLENDALE, CA 91206-4282
(310) 621-4951
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
CA19760
CA
111NN1001X
Nutrition Chiropractor
CA19760
CA
302R00000X
Health Maintenance Organization
Primary
G62334
CA
Other
Enumeration date
09/29/2014
Last updated
09/29/2014
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