Provider Demographics
NPI:1861902611
Name:PRIMER HEALTHCARE
Entity type:Organization
Organization Name:PRIMER HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER / PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PRISCILLA
Authorized Official - Middle Name:NAAMOMO
Authorized Official - Last Name:OTUBUAH
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:909-283-4033
Mailing Address - Street 1:24950 REDLANDS BLVD STE F
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-4028
Mailing Address - Country:US
Mailing Address - Phone:909-283-4033
Mailing Address - Fax:855-621-1987
Practice Address - Street 1:24950 REDLANDS BLVD STE F
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-4028
Practice Address - Country:US
Practice Address - Phone:909-283-4033
Practice Address - Fax:855-621-1987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-06
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95000921OtherNP LICENSE