Healthcare Provider Details

I. General information

NPI: 1417085358
Provider Name (Legal Business Name): PHYSICIANS INTEGRATED MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 02/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2482 MISSION ST
SAN FRANCISCO CA
94110-2415
US

IV. Provider business mailing address

2482 MISSION ST
SAN FRANCISCO CA
94110-2415
US

V. Phone/Fax

Practice location:
  • Phone: 415-970-2545
  • Fax: 415-970-1600
Mailing address:
  • Phone: 415-970-2545
  • Fax: 415-970-1600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License NumberC1953423
License Number StateCA

VIII. Authorized Official

Name: MR. JAMES RODRIGUEZ
Title or Position: CEO
Credential:
Phone: 415-970-2545