Provider Demographics
NPI:1679190664
Name:PRIME MOBILE PHYSICIANS NETWORK, INC
Entity type:Organization
Organization Name:PRIME MOBILE PHYSICIANS NETWORK, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:IZUCHUKWU
Authorized Official - Middle Name:
Authorized Official - Last Name:OKPARA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-228-3538
Mailing Address - Street 1:25044 PEACHLAND AVE STE 209
Mailing Address - Street 2:
Mailing Address - City:NEWHALL
Mailing Address - State:CA
Mailing Address - Zip Code:91321-5751
Mailing Address - Country:US
Mailing Address - Phone:613-837-1366
Mailing Address - Fax:818-356-4380
Practice Address - Street 1:28212 KELLY JOHNSON PKWY STE 200
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-5090
Practice Address - Country:US
Practice Address - Phone:213-228-3538
Practice Address - Fax:818-356-4380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-25
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty