Provider Demographics
NPI:1164100061
Name:PRIME HEALTH ASSESSMENT MEDICAL GROUP INC
Entity Type:Organization
Organization Name:PRIME HEALTH ASSESSMENT MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEE
Authorized Official - Middle Name:BELLA
Authorized Official - Last Name:MANDAP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-897-7321
Mailing Address - Street 1:4050 AIRPORT CENTER DR STE B1
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92264-1216
Mailing Address - Country:US
Mailing Address - Phone:916-897-7321
Mailing Address - Fax:
Practice Address - Street 1:4050 AIRPORT CENTER DR STE B1
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92264-1216
Practice Address - Country:US
Practice Address - Phone:916-897-7321
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center