Provider Demographics
NPI:1578849980
Name:PRIMICH, CHARLES (NP)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:
Last Name:PRIMICH
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 BERNICE ST
Mailing Address - Street 2:UNIT 206
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-4348
Mailing Address - Country:US
Mailing Address - Phone:415-336-4723
Mailing Address - Fax:
Practice Address - Street 1:8 BERNICE ST
Practice Address - Street 2:UNIT 206
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-4348
Practice Address - Country:US
Practice Address - Phone:415-336-4723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-30
Last Update Date:2011-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21423363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health