Provider Demographics
NPI:1215304753
Name:PARNELL MEDICAL CORPORATION
Entity type:Organization
Organization Name:PARNELL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLE
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:SARGANIS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:415-461-1036
Mailing Address - Street 1:1030 SIR FRANCIS DRAKE BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:KENTFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94904-1411
Mailing Address - Country:US
Mailing Address - Phone:415-461-1036
Mailing Address - Fax:415-461-1043
Practice Address - Street 1:1030 SIR FRANCIS DRAKE BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:KENTFIELD
Practice Address - State:CA
Practice Address - Zip Code:94904-1411
Practice Address - Country:US
Practice Address - Phone:415-461-1036
Practice Address - Fax:415-461-1043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-01
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA540722261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care