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 PRATICE OPERATIONS)
(415) 842-5103
Entity
Organization
Contact information
Practice address
100 A DRAKES LANDING RD, SUITE 225, GREENBRAE, CA 94904-3119
(415) 461-7800
Mailing address
4 HAMILTON LNDG, SUITE 100, NOVATO, CA 94949-8256
(415) 884-1840
(415) 884-3510
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
—
—
208600000X
Surgery Physician
A65187
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZZ03538Z
MEDICARE PTAN
CA
Enumeration date
09/02/2011
Last updated
07/21/2015
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