PRIMA MEDICAL FOUNDATION SEBASTOPOL (NPI# 1154590958) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1154590958 |
| Entity Type | Organization |
| Organization Name | PRIMA MEDICAL FOUNDATION SEBASTOPOL |
| Other Organization Name | PRIMA MEDICAL GROUP |
| Practice Address |
652 Petaluma Ave Suite H Sebastopol CA 95472-4256 |
| Mailing Address |
4 Hamilton Lndg Ste 100 Novato CA 94949-8247 |
| Practice Telephone | 7078237616 |
| Practice Fax Number | 7078232803 |
| Mailing Telephone | 4158841840 |
| Enumeration Date | 2008-02-26 |
| Last Update Date | 2013-04-24 |
| Authorized Official Name | DENNIS MONDRAGON (COO) |
| Authorized Official Telephone | 4158841840 |
| Is Organization Subpart | Y |
| Parent Organization Name | PRIMA MEDICAL FOUNDATION |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QP2300X |
Clinic/Center Specialization: Primary Care |
Ambulatory Health Care Facilities | ||
| Y | 261QM1300X |
Clinic/Center Specialization: Multi-Specialty |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Prima Medical Group | Doing Business As Name - Organization |
| Street Address |
652 PETALUMA AVE SUITE H |
| City | SEBASTOPOL |
| State | CA |
| Zip Code | 95472-4256 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962401463 | Misty Michelle Zelk | Internal Medicine | 652 Petaluma Ave, Suite H, Sebastopol, CA 95472-4256 | 2005-07-18 |
| 1275016230 | Connie Alejandrina Moreno | Nurse Practitioner | 652 Petaluma Ave, Sebastopol, CA 95472-4256 | 2018-09-14 |
| 1114382751 | Shelleen E Denno Md Inc. | Internal Medicine | 652 Petaluma Ave, Suite D, Sebastopol, CA 95472-4256 | 2015-12-28 |
| 1861809501 | West County Health Centers, Inc. | Clinic/Center | 652 Petaluma Ave, Sebastopol, CA 95472-4256 | 2014-07-15 |
| 1902244528 | Prima Medical Foundation | General Practice | 652 Petaluma Ave, Suite H, Sebastopol, CA 95472-4256 | 2013-06-05 |
| 1336496710 | Emilio Licea IIi | Psychologist | 652 Petaluma Ave, Sebastopol, CA 95472-4256 | 2012-08-05 |
| 1184845182 | Northern California Medical Assoc Inc | Internal Medicine | 652 Petaluma Ave, Ste E, Sebastopol, CA 95472-4266 | 2007-05-01 |
| 1871665471 | Scott Benstock | Dentist | 652 Petaluma Ave, Suite A, Sebastopol, CA 95472-4256 | 2006-11-15 |
| 1992889067 | Allan L. Bernstein | Psychiatry & Neurology | 652 Petaluma Ave, Suite H, Sebastopol, CA 95472-4256 | 2006-10-25 |
| 1497842835 | Sutter Medical Group of The Redwoods | Obstetrics & Gynecology | 652 Petaluma Ave, Suite F, Sebastopol, CA 95472-4256 | 2006-10-06 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558916791 | Mellisa Nicole Elrod | Occupational Therapist | 1935 Gravenstein Hwy, Sebastopol, CA 95472 | 2019-08-05 |
| 1457820987 | Isabel Brooke Martinez | Acupuncturist | 961 Gravenstein Hwy South, # 100, Sebastopol, CA 95472 | 2018-11-14 |
| 1275025470 | Shahbano Syeda | Specialist/Technologist | 846/848 Gravenstein Hwy South, Sebastopol, CA 95472 | 2018-06-04 |
| 1467990812 | Mathew Metzgar | Marriage & Family Therapist | 1800 N. Gravenstein Hwy, Sebastopol, CA 95472 | 2017-02-06 |
| 1760939318 | Andrea Kirk | Psychologist | 876 Gravenstein Hwy S., Suite 6, Sebastopol, CA 95472 | 2016-09-01 |
| 1548629371 | Stacy Simons | Massage Therapist | 103 Morris St Ste V, Sebastopol, CA 95472 | 2016-02-22 |
| 1619341880 | Carol Schmid | Counselor | 1800 N, Gravenstein Hwy, Sebastopol, CA 95472 | 2015-11-25 |
| 1801273727 | Aaron Martinez | Specialist/Technologist | 7441 Witter Road, Sebastopol, CA 95472 | 2015-04-29 |
| 1699167049 | Nia Kaye | Marriage & Family Therapist | 130 Petaluma Ave Ste 2c, Sebastopol, CA 95472 | 2015-02-23 |
| 1497091383 | Caitlin Marie Kirkman | Midwife | 5611 Hessel Ave, Sebastopol, CA 95472 | 2012-12-20 |
| Find all providers in zip 95472 | ||||
| Taxonomy Code | 261QM1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Multi-Specialty |
| Definition to come... |
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| Find all providers with the same taxonomy | ||||
| City | SEBASTOPOL |
| Zip Code | 95472 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.