Healthcare Provider Details

I. General information

NPI: 1538256193
Provider Name (Legal Business Name): PRIME HEALTH MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 02/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3228 SANTA ANITA AVE
EL MONTE CA
91733-1360
US

IV. Provider business mailing address

3228 SANTA ANITA AVE
EL MONTE CA
91733-1360
US

V. Phone/Fax

Practice location:
  • Phone: 626-444-9161
  • Fax:
Mailing address:
  • Phone: 626-444-9161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberA31083
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberA33207
License Number StateCA

VIII. Authorized Official

Name: DR. MARIA EUGENIA KHALATIAN
Title or Position: MEDICAL DOCTOR
Credential: M.D.
Phone: 626-444-9161