Provider Demographics
NPI:1083904627
Name:PREVENT PREMATURE AGING MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:PREVENT PREMATURE AGING MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:GEORGETA
Authorized Official - Last Name:GHERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD MPH
Authorized Official - Phone:650-533-4105
Mailing Address - Street 1:2610 HALLMARK DR
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94002-2912
Mailing Address - Country:US
Mailing Address - Phone:650-533-4105
Mailing Address - Fax:
Practice Address - Street 1:2900 WHIPPLE AVE STE 115
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94062-2858
Practice Address - Country:US
Practice Address - Phone:650-533-4105
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-16
Last Update Date:2011-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA392642083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental MedicineGroup - Single Specialty