Healthcare Provider Details

I. General information

NPI: 1134898844
Provider Name (Legal Business Name): PRIME MED GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2021
Last Update Date: 05/20/2022
Certification Date: 05/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13132 STUDEBAKER RD STE 7
NORWALK CA
90650-2562
US

IV. Provider business mailing address

20430 STARSHINE RD
WALNUT CA
91789-3539
US

V. Phone/Fax

Practice location:
  • Phone: 562-525-7118
  • Fax: 562-991-6130
Mailing address:
  • Phone: 562-508-7123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ANDREW PASCUAL
Title or Position: PRESIDENT
Credential:
Phone: 562-508-7123