MEDICARE: PRIMCARE MEDICAL CENTER INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QG0300X	Geriatric Medicine (Family Medicine) Physician

General Provider Information

NPI Number	:	1033082318
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIMCARE MEDICAL CENTER INC

Provider Business Mailing Address
First Line	:	11755 VICTORY BLVD STE 100B
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91606-3423
Country	:	US
Telephone Number	:	747-203-1909
Fax Number	:	747-205-2063

Provider Business Practice Location Address
First Line	:	11755 VICTORY BLVD STE 100B
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91606-3423
Country	:	US
Telephone Number	:	747-203-1909
Fax Number	:	747-205-2063

Authorized Official
Title or Position	:	CEO/ OWNER
Name	:	NICHOLAS DZEBOLO
Credential	:	MD
Telephone Number	:	747-265-6308

Provider Enumeration Date	:	09/24/2025
Last Update Date	:	01/15/2026

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Directions to “PRIMCARE MEDICAL CENTER INC ” Practice Location

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