Healthcare Provider Details

I. General information

NPI: 1801466396
Provider Name (Legal Business Name): PRIVILEGE MEDICAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2021
Last Update Date: 06/28/2021
Certification Date: 06/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 E 20TH ST # E523
CHICO CA
95928-6369
US

IV. Provider business mailing address

660 ROYCE LN
CHICO CA
95973-8703
US

V. Phone/Fax

Practice location:
  • Phone: 714-720-9162
  • Fax:
Mailing address:
  • Phone: 732-322-3260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MARIA NERISSA PRIETO
Title or Position: PRESIDENT/OWNER
Credential: MD
Phone: 732-322-3260