Organization
PRIME ACCESS MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GABRIELLE GONZALEZ (CREDENTIALING SPECIALIST)
(909) 684-4404
Entity
Organization
Contact information
Practice address
12611 9TH ST, CHINO, CA 91710-3528
(626) 657-8002
(626) 270-4328
Mailing address
201 W GARVEY AVE STE 102-502, MONTEREY PARK, CA 91754-7418
(626) 657-8002
Taxonomy
Speciality
Code
Description
License number
State
2085R0204X
Vascular & Interventional Radiology Physician
Primary
—
—
208800000X
Urology Physician
—
—
Other
Enumeration date
09/20/2024
Last updated
09/20/2024
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