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General NPI Number Information
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NPI Number | 1396625612
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Entity Type | Organization
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Legal Business Name | PRIME PATH MEDICAL GROUP MD
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Dates
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Enumeration Date | 09/05/2025
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Last Update Date | 09/05/2025
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Provider Practice Location Address
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Address Line | 1500 S CENTRAL AVE STE 323
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City | GLENDALE
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State | CA
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Zip | 91204-3858
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Country | US
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Telephone | 747-200-6948
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Fax | 747-800-8005
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Provider Business Mailing Address
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Address Line | 1500 S CENTRAL AVE STE 323
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City | GLENDALE
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State | CA
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Zip | 91204-3858
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Country | US
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Telephone | 747-200-6948
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Fax | 747-800-8005
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Authorized Official
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Title or Position | MD, CO-OWNER, PREDIDENT
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Name | DR. MASON ALEXANDER BRAGG
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Credential |
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Telephone | 747-800-8005
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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