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General NPI Number Information
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NPI Number | 1033503446
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Entity Type | Organization
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Legal Business Name | PRIMA MEDICAL FOUNDATION
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Dates
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Enumeration Date | 03/24/2015
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Last Update Date | 03/24/2015
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Provider Practice Location Address
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Address Line | 75 ROWLAND WAY SUITE 275
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City | NOVATO
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State | CA
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Zip | 94945-5037
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Country | US
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Telephone | 415-461-7800
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Fax |
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Provider Business Mailing Address
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Address Line | 9 COMMERCIAL BLVD SUITE 200
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City | NOVATO
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State | CA
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Zip | 94949-6118
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Country | US
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Telephone | 415-842-5038
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | WAYNE FAIRCHILD
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Credential |
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Telephone | 415-842-5101
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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