Healthcare Provider Details

I. General information

NPI: 1881799583
Provider Name (Legal Business Name): PRIME MEDICAL ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 05/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 HARRISON ST
OAKLAND CA
94607-4422
US

IV. Provider business mailing address

817 HARRISON ST
OAKLAND CA
94607-4422
US

V. Phone/Fax

Practice location:
  • Phone: 510-451-8088
  • Fax: 510-451-8088
Mailing address:
  • Phone: 510-451-8088
  • Fax: 510-451-8088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberG9021
License Number StateCA

VIII. Authorized Official

Name: PAULINE VALERIANO-DER
Title or Position: OFFICE ADMINISTRATOR
Credential:
Phone: 510-451-8088