| Primelife Medical Group, Inc. | |
|
8100 Timberlake Way Suite C Sacramento CA 95823-5409 | |
| (916) 681-5000 | |
| (916) 681-5887 |
| Full Name | Primelife Medical Group, Inc. |
|---|---|
| Speciality | Family Medicine |
| Location | 8100 Timberlake Way, Sacramento, California |
| Authorized Official Name and Position | Caesar Locsin Ibanez (CEO) |
| Authorized Official Contact | 9166815000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Primelife Medical Group, Inc. 8100 Timberlake Way Suite C Sacramento CA 95823-5409 Ph: (916) 681-5000 | Primelife Medical Group, Inc. 8100 Timberlake Way Suite C Sacramento CA 95823-5409 Ph: (916) 681-5000 |
| NPI Number | 1629022561 |
|---|---|
| Provider Enumeration Date | 05/22/2006 |
| Last Update Date | 05/21/2012 |
| Medicare PECOS PAC ID | 3173786530 |
|---|---|
| Medicare Enrollment ID | O20120522000939 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629022561 | NPI | - | NPPES |
| 00A645050 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | A64505 (California) | Primary |
| Provider Name | Marcelina Gutierrez Ibanez |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1295917417 PECOS PAC ID: 3971766338 Enrollment ID: I20120522000962 |
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