Organization
PRIME PARTNERS IPA MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FETSUS DADA M.D. (PRESIDENT)
(951) 973-7294
Entity
Organization
Contact information
Practice address
25470 MEDICAL CENTER DR, SUITE 204, MURRIETA, CA 92562-4900
(951) 973-7294
(951) 973-7299
Mailing address
25470 MEDICAL CENTER DR, SUITE 204, MURRIETA, CA 92562-4900
(951) 973-7294
(951) 973-7299
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
A40801
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2506434
ARTICLES OF CORPORATION
CA
Enumeration date
11/08/2007
Last updated
11/08/2007
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