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Organization

PRIMARY ACCESS MEDICAL GROUP, INC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
BRENT PRATLEY MD (MEDICAL DIRECTOR)
(562) 728-9600
Entity
Organization

Contact information

Practice address
273 E SOUTH ST, LONG BEACH, CA 90805-4631
(562) 728-9600
(562) 422-9011
Mailing address
PO BOX 607, SAN DIMAS, CA 91773-0607
(909) 971-9334
(909) 971-9654

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
A54374
CA
208D00000X
General Practice Physician
Primary
A36774
CA

Other

Enumeration date
12/16/2008
Last updated
12/16/2008
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