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General NPI Number Information
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NPI Number | 1497971584
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Entity Type | Organization
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Legal Business Name | PERMANENTE MEDICAL GROUP, INC
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Dates
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Enumeration Date | 04/17/2007
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Last Update Date | 11/20/2024
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Provider Practice Location Address
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Address Line | 5755 COTTLE RD BLDG 6 TPMG REGIONAL GENETICS LAB
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City | SAN JOSE
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State | CA
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Zip | 95123-3640
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Country | US
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Telephone | 408-972-3308
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Fax |
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Provider Business Mailing Address
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Address Line | 5820 OWENS DR. BUILDING E, 2ND FLOOR TPMG FINANCIAL MANAGEMENT
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City | PLEASANTON
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State | CA
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Zip | 94588-3900
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | VP FINANCE
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Name | MS. PATRICIA T WEST
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Credential |
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Telephone | 510-295-7207
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | CLF 11121
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License Number State | CA
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