Provider Demographics
NPI:1508226200
Name:PRIVATE MEDICAL PHYSICIANS INC.
Entity Type:Organization
Organization Name:PRIVATE MEDICAL PHYSICIANS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:SARMIENTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-830-3090
Mailing Address - Street 1:3580 CALIFORNIA ST STE 202
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-1717
Mailing Address - Country:US
Mailing Address - Phone:415-830-3090
Mailing Address - Fax:
Practice Address - Street 1:3580 CALIFORNIA ST STE 202
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-1717
Practice Address - Country:US
Practice Address - Phone:415-830-3090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-24
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA73730207R00000X
CAA061482208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty