Basic Information
| Provider Information | |||||||||
| NPI: | 1972675718 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PRIME PARTNERS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25470 MEDICAL CENTER DR | ||||||||
| Address2: | SUITE 206 | ||||||||
| City: | MURRIETA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925624900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9519737380 | ||||||||
| FaxNumber: | 9519737389 | ||||||||
| Practice Location | |||||||||
| Address1: | 31720 TEMECULA PKWY | ||||||||
| Address2: | SUITE 204 | ||||||||
| City: | TEMECULA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925925895 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9513021576 | ||||||||
| FaxNumber: | 9512966149 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/15/2006 | ||||||||
| LastUpdateDate: | 04/20/2008 | ||||||||
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| AuthorizedOfficialLastName: | LEE | ||||||||
| AuthorizedOfficialFirstName: | DONALD | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9519737380 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.