Organization
PRIMA MEDICAL FOUNDATION
Active
Parent organization
PRIMA MEDICAL FOUNDATION
Organization subpart
Yes
Provider details
NPI number
Legal business name
PRIMA MEDICAL FOUNDATION
Authorized official
JOANNA RUBEL (SR. DIRECTOR OF PRACTICE OPERATIONS)
(415) 842-5103
Entity
Organization
Contact information
Practice address
1260 S ELISEO DR, FLOOR 2, GREENBRAE, CA 94904-2009
(415) 461-7800
(415) 924-1375
Mailing address
9 COMMERCIAL BLVD, SUITE 200, NOVATO, CA 94949-6118
(415) 842-5000
Taxonomy
Speciality
Code
Description
License number
State
207RI0011X
Interventional Cardiology Physician
G88295
CA
207RP1001X
Pulmonary Disease Physician
G45217
CA
208D00000X
General Practice Physician
Primary
A72388
CA
208D00000X
General Practice Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZZ03538Z
MEDICARE
CA
Enumeration date
10/07/2005
Last updated
08/13/2015
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