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General NPI Number Information
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NPI Number | 1609157734
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Entity Type | Organization
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Legal Business Name | PRIMA MEDICAL FOUNDATION
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Dates
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Enumeration Date | 09/02/2011
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Last Update Date | 07/21/2015
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Provider Practice Location Address
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Address Line | 100 A DRAKES LANDING RD SUITE 225
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City | GREENBRAE
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State | CA
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Zip | 94904-3119
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Country | US
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Telephone | 415-461-7800
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Fax |
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Provider Business Mailing Address
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Address Line | 4 HAMILTON LNDG SUITE 100
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City | NOVATO
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State | CA
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Zip | 94949-8256
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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 | SR. DIRECTOR OF PRATICE OPERATIONS
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Name | JOANNA RUBEL
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Credential |
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Telephone | 415-842-5103
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | A65187
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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