Provider Demographics
NPI:1326850769
Name:PRIMECARE MOBILE LLC
Entity type:Organization
Organization Name:PRIMECARE MOBILE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:TUANQUI
Authorized Official - Last Name:CASTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC,FNP-C
Authorized Official - Phone:623-399-2513
Mailing Address - Street 1:1401 21ST ST # 5512
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95811-5226
Mailing Address - Country:US
Mailing Address - Phone:623-399-2513
Mailing Address - Fax:
Practice Address - Street 1:1401 21ST ST # 5512
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95811-5226
Practice Address - Country:US
Practice Address - Phone:623-399-2513
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-23
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care