Basic Information
| Provider Information | |||||||||
| NPI: | 1215268479 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PRIMA HEART, A MEDICAL GROUP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3037 | ||||||||
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| City: | PINEDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 936503037 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5594360871 | ||||||||
| FaxNumber: | 5594355221 | ||||||||
| Practice Location | |||||||||
| Address1: | 1010 CASS ST | ||||||||
| Address2: | A-2 | ||||||||
| City: | MONTEREY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939404515 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8313331345 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/27/2010 | ||||||||
| LastUpdateDate: | 01/27/2010 | ||||||||
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| AuthorizedOfficialLastName: | KARAHALIOS | ||||||||
| AuthorizedOfficialFirstName: | SOTERIA | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | AUTHORIZED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 8313331345 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No ID Information.