Provider Demographics
NPI:1235507070
Name:PRIMAVERA, DMITRI
Entity Type:Individual
Prefix:
First Name:DMITRI
Middle Name:
Last Name:PRIMAVERA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7171 BOWLING DR STE 911
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-2034
Mailing Address - Country:US
Mailing Address - Phone:916-875-0722
Mailing Address - Fax:916-875-0714
Practice Address - Street 1:7171 BOWLING DR STE 911
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-2034
Practice Address - Country:US
Practice Address - Phone:916-875-0722
Practice Address - Fax:916-875-0714
Is Sole Proprietor?:No
Enumeration Date:2015-09-10
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker