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General NPI Number Information
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NPI Number | 1154377489
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Entity Type | Organization
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Legal Business Name | PRIMA MEDICAL GROUP, INC.
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Dates
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Enumeration Date | 05/26/2006
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Last Update Date | 09/04/2008
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Provider Practice Location Address
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Address Line | 4000 CIVIC CENTER DR #200B
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City | SAN RAFAEL
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State | CA
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Zip | 94903-4171
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Country | US
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Telephone | 415-492-3333
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Fax | 415-492-3425
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Provider Business Mailing Address
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Address Line | 3 HAMILTON LANDING #160
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City | NOVATO
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State | CA
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Zip | 94948
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Country | US
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Telephone | 415-884-1840
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Fax | 415-884-3510
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Authorized Official
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Title or Position | PHYSICIAN/MEDICAL DIRECTOR
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Name | MR. JOSEPH A HABRIS
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Credential | M.D
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Telephone | 415-492-3333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | G73451
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License Number State | CA
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