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Contact Information

PRIMA MEDICAL FOUNDATION
655 REDWOOD HIGHWAY
SUITE 216
MILL VALLEY, CA94941
 Phone: 415-383-3500
 Fax: 415-383-3554
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Pediatrics

208000000X 37 Physician/Pediatric Medicine
 

General Practice

208D00000X 99 Physician/Undefined Physician type[6]
 

Surgery

208600000X 02 Physician/General Surgery
Indicates primary specialty

NPI Profile & details for PRIMA MEDICAL FOUNDATION

NPI Number 1366606766
LBN Legal business name PRIMA MEDICAL FOUNDATION
Authorized official JOEL CRISTE - (CEO)
Entity Organization
Organization subpart 1 Yes
Enumeration date 07/15/2008
Last updated 08/31/2012 - About 14 years ago
Identifiers
CA License # A65187
CA License # A77821
CA License # G55637
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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