Provider Demographics
NPI:1154377489
Name:PRIMA MEDICAL GROUP, INC.
Entity type:Organization
Organization Name:PRIMA MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/MEDICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:A
Authorized Official - Last Name:HABRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-492-3333
Mailing Address - Street 1:3 HAMILTON LANDING
Mailing Address - Street 2:#160
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94948
Mailing Address - Country:US
Mailing Address - Phone:415-884-1840
Mailing Address - Fax:415-884-3510
Practice Address - Street 1:4000 CIVIC CENTER DR
Practice Address - Street 2:#200B
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-4171
Practice Address - Country:US
Practice Address - Phone:415-492-3333
Practice Address - Fax:415-492-3425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG73451207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ03538ZMedicare ID - Type Unspecified