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General NPI Number Information
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NPI Number | 1255256491
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Entity Type | Organization
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Legal Business Name | PRIMECARE MEDICAL GROUP, INC.
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Dates
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Enumeration Date | 08/13/2026
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Last Update Date | 08/13/2026
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Provider Practice Location Address
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Address Line | 100 E ST STE 301
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City | SANTA ROSA
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State | CA
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Zip | 95404-4607
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Country | US
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Telephone | 369-208-7688
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Fax | 369-208-7674
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Provider Business Mailing Address
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Address Line | 100 E ST STE 301
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City | SANTA ROSA
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State | CA
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Zip | 95404-4607
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Country | US
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Telephone | 369-208-7688
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Fax | 369-208-7674
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Authorized Official
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Title or Position | CEO
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Name | ANTHONY OGUGU
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Credential |
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Telephone | 369-208-7688
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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