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General NPI Number Information
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NPI Number | 1134898844
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Entity Type | Organization
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Legal Business Name | PRIME MED GROUP INC
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Dates
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Enumeration Date | 09/08/2021
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Last Update Date | 05/20/2022
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Provider Practice Location Address
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Address Line | 13132 STUDEBAKER RD STE 7
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City | NORWALK
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State | CA
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Zip | 90650-2562
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Country | US
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Telephone | 562-525-7118
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Fax | 562-991-6130
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Provider Business Mailing Address
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Address Line | 20430 STARSHINE RD
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City | WALNUT
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State | CA
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Zip | 91789-3539
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Country | US
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Telephone | 562-508-7123
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ANDREW PASCUAL
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Credential |
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Telephone | 562-508-7123
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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