PRIMA MEDICAL FOUNDATION NPI 1902244528

NPI Information

  • NPI: 1902244528
  • Provider Name: PRIMA MEDICAL FOUNDATION
  • Classification: General Practice - 208D00000X
  • Entity Type: Organization
  • Doing Business As: PRIMA MEDICAL GROUP
  • Address: 652 PETALUMA AVE
    SUITE H
    SEBASTOPOL, CA
    ZIP 95472
  • Phone: (707) 823-7616

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NPI Details

PRIMA MEDICAL FOUNDATION is a general practice in Sebastopol, CA. The provider is a physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee PRIMA MEDICAL FOUNDATION NPI is 1902244528. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Prima Medical Group.

The provider's business location address is:

652 PETALUMA AVE
SUITE H
SEBASTOPOL, CA
ZIP 95472-256
Phone: (707) 823-7616
Fax: (707) 823-2803

The provider's authorized official is Dennis Mondragon .
The authorized official title is Coo and has the following contact phone number (415) 884-1840.

The enumeration date for this NPI number is 6/5/2013 and was last updated on 6/5/2013.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1208D00000XGeneral PracticeYes

What is NPI?

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This page was last updated on: 11/21/2025

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