Provider Demographics
NPI:1184269177
Name:PRIMEHEALTH 360 INC
Entity type:Organization
Organization Name:PRIMEHEALTH 360 INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NINA
Authorized Official - Middle Name:K
Authorized Official - Last Name:MAW MAW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-444-1422
Mailing Address - Street 1:79440 CORPORATE CENTER DR STE 111A
Mailing Address - Street 2:
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92253-7243
Mailing Address - Country:US
Mailing Address - Phone:760-444-1422
Mailing Address - Fax:
Practice Address - Street 1:79440 CORPORATE CENTER DR STE 111A
Practice Address - Street 2:
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-7243
Practice Address - Country:US
Practice Address - Phone:760-444-1422
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-13
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty