Prim Health Services Inc

Primary specialty

MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X

License

A72562 Issued in CA

Legal business name

PRIM HEALTH SERVICES INC

Practice address

5150 Wilshire Blvd
Suite 603
Los Angeles, CA 90036-4303

Phone

(213) 995-5054

Fax

(213) 652-1908

NPI assigned

Oct 9, 2009

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Stephen D Maberry, M.D.NPI 1093754756

Title

President

Phone

(213) 995-5054

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Stephen D Maberry, MD

  • MOHS-Micrographic Surgery Physician
  • Fort Worth, TX
  • NPI 1093754756
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1255046400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1255046400000",
    "number": "1174858153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1317 N SAN FERNANDO BLVD",
            "address_2": "301",
            "city": "BURBANK",
            "state": "CA",
            "postal_code": "915044236",
            "telephone_number": "213-995-5054",
            "fax_number": "213-652-1908"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5150 WILSHIRE BLVD",
            "address_2": "SUITE 603",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900364303",
            "telephone_number": "213-995-5054",
            "fax_number": "213-652-1908"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIM HEALTH SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-09",
        "last_updated": "2009-10-09",
        "status": "A",
        "authorized_official_last_name": "MABERRY",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "213-995-5054",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207ND0101X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "CA",
            "license": "A72562",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nancy Prieto
• Raul R. Prieto, MD
• Mario Manuel Prietto, L.C.S.W.
• Alyssa C Prigge
• Yigal Prilutsky, D.M.D.
• Prima Pain Therapy Group, Inc
• Primary Care Consulting a Medical Corp
• Primary Care Health Clinic
• Primary Group Solutions Foundation Inc
• Primary Group Solutions, LLC

• MOHS-Micrographic Surgery Physician in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• MOHS-Micrographic Surgery Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.