Provider Demographics
NPI:1811217946
Name:PRIMA MEDICAL FOUNDATION
Entity Type:Organization
Organization Name:PRIMA MEDICAL FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:CRISTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-884-1840
Mailing Address - Street 1:4 HAMILTON LANDING
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94949
Mailing Address - Country:US
Mailing Address - Phone:415-884-1840
Mailing Address - Fax:415-884-3510
Practice Address - Street 1:4 HAMILTON LANDING
Practice Address - Street 2:SUITE 100
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94949
Practice Address - Country:US
Practice Address - Phone:415-884-1840
Practice Address - Fax:415-884-3510
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRIMA MEDICAL FOUNDATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-06-11
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center