Healthcare Provider Details

I. General information

NPI: 1255256491
Provider Name (Legal Business Name): PRIMECARE MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E ST STE 301
SANTA ROSA CA
95404-4607
US

IV. Provider business mailing address

100 E ST STE 301
SANTA ROSA CA
95404-4607
US

V. Phone/Fax

Practice location:
  • Phone: 369-208-7688
  • Fax: 369-208-7674
Mailing address:
  • Phone: 369-208-7688
  • Fax: 369-208-7674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANTHONY OGUGU
Title or Position: CEO
Credential:
Phone: 369-208-7688