1356422083 NPI number — PROGRESSIVE HEALTH CARE PROVIDERS, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356422083 NPI number — PROGRESSIVE HEALTH CARE PROVIDERS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PROGRESSIVE HEALTH CARE PROVIDERS, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356422083
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9612 VAN NUYS BLVD
Provider Second Line Business Mailing Address:
SUITE 207
Provider Business Mailing Address City Name:
PANORAMA CITY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91402-1044
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-830-6444
Provider Business Mailing Address Fax Number:
818-830-6680

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9612 VAN NUYS BLVD
Provider Second Line Business Practice Location Address:
SUITE 207
Provider Business Practice Location Address City Name:
PANORAMA CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91402-1044
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-830-6444
Provider Business Practice Location Address Fax Number:
818-830-6680
Provider Enumeration Date:
10/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BOGERT
Authorized Official First Name:
FLORDELIZ
Authorized Official Middle Name:
MAC
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
818-830-6444

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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