Provider Demographics
NPI:1689870008
Name:PRINCESSA INTEGRATIVE MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:PRINCESSA INTEGRATIVE MEDICAL ASSOCIATES
Other - Org Name:PRIMA HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROCHELLE
Authorized Official - Middle Name:C
Authorized Official - Last Name:FELDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-424-0900
Mailing Address - Street 1:18520 VIA PRINCESSA
Mailing Address - Street 2:SUITE C-2
Mailing Address - City:CANYON COUNTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91387-8326
Mailing Address - Country:US
Mailing Address - Phone:661-424-0900
Mailing Address - Fax:661-424-0924
Practice Address - Street 1:18520 VIA PRINCESSA
Practice Address - Street 2:SUITE C-2
Practice Address - City:CANYON COUNTRY
Practice Address - State:CA
Practice Address - Zip Code:91387-8326
Practice Address - Country:US
Practice Address - Phone:661-424-0900
Practice Address - Fax:661-424-0924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27810111NX0100X
CAA84167207R00000X
CAG32408208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered111NX0100XChiropractic ProvidersChiropractorOccupational HealthGroup - Multi-Specialty
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW19307Medicare ID - Type Unspecified