Healthcare Provider Details

I. General information

NPI: 1053275859
Provider Name (Legal Business Name): PERMANENTE HEALTH, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17284 SLOVER AVE
FONTANA CA
92337-7584
US

IV. Provider business mailing address

8735 DUNWOODY PL # 5070
ATLANTA GA
30350-2995
US

V. Phone/Fax

Practice location:
  • Phone: 877-608-0044
  • Fax:
Mailing address:
  • Phone: 404-470-6070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: RAMIN DAVIDOFF
Title or Position: CEO/PRESIDENT
Credential: M.D.
Phone: 877-608-0044