Healthcare Provider Details

I. General information

NPI: 1780421925
Provider Name (Legal Business Name): PRIMEMED MEDICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2024
Last Update Date: 07/15/2024
Certification Date: 07/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 S VINCENT AVE STE 206
WEST COVINA CA
91790-6712
US

IV. Provider business mailing address

11 ROCK SPRINGS WAY
AZUSA CA
91702-6270
US

V. Phone/Fax

Practice location:
  • Phone: 909-570-7787
  • Fax:
Mailing address:
  • Phone: 626-205-8488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. DELONG CAO
Title or Position: SECRETARY
Credential:
Phone: 626-205-8488