| Organization Name: | PRIME FAMILY CLINIC INC |
| NPI Number: | 1942682596 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | OMAR E ESPINOSA (PRESIDENT/CEO) |
| Mailing Address: | 1110 S Glendale Ave E Glendale |
| State: | CA US |
| Postal Code: | 912055617 |
| Phone Number: | 8189455502 |
| Fax Number: | 8189455595 |
| NPI Enumeration Date: | 06/19/2015 |
| NPI Last Update Date: | 06/19/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | A23122 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |