Provider Demographics
NPI:1871986265
Name:PRIMARY HEALTHCARE PLUS MEDICAL GROUP INC
Entity type:Organization
Organization Name:PRIMARY HEALTHCARE PLUS MEDICAL GROUP INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:GARCIA
Authorized Official - Last Name:MAYHAY-LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-266-2900
Mailing Address - Street 1:2900 FRESNO ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93721-1439
Mailing Address - Country:US
Mailing Address - Phone:559-266-2900
Mailing Address - Fax:559-268-2900
Practice Address - Street 1:2900 FRESNO ST
Practice Address - Street 2:SUITE 106
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93721-1439
Practice Address - Country:US
Practice Address - Phone:559-266-2900
Practice Address - Fax:559-268-2900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-10
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA52879207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty