Provider Demographics
NPI:1902659733
Name:PRIME MDCARE INC
Entity Type:Organization
Organization Name:PRIME MDCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:PRODE
Authorized Official - Middle Name:P
Authorized Official - Last Name:PASCUAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-910-7329
Mailing Address - Street 1:20430 STARSHINE RD
Mailing Address - Street 2:
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-3539
Mailing Address - Country:US
Mailing Address - Phone:310-910-7329
Mailing Address - Fax:310-388-0126
Practice Address - Street 1:20430 STARSHINE RD
Practice Address - Street 2:
Practice Address - City:WALNUT
Practice Address - State:CA
Practice Address - Zip Code:91789-3539
Practice Address - Country:US
Practice Address - Phone:310-910-7329
Practice Address - Fax:310-388-0126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty