1225228703 NPI number — PROLIFIC HEALTH CARE, INC.

Table of content: (NPI 1225228703)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225228703 NPI number — PROLIFIC HEALTH CARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PROLIFIC HEALTH CARE, 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:
6
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:
1225228703
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/22/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12631 IMPERIAL HWY
Provider Second Line Business Mailing Address:
SUITE C-105
Provider Business Mailing Address City Name:
SANTA FE SPRINGS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90670-4710
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
562-864-2627
Provider Business Mailing Address Fax Number:
562-864-2757

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12631 IMPERIAL HWY
Provider Second Line Business Practice Location Address:
SUITE C-105
Provider Business Practice Location Address City Name:
SANTA FE SPRINGS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90670-4710
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-864-2627
Provider Business Practice Location Address Fax Number:
562-864-2757
Provider Enumeration Date:
07/31/2007

Additional Information

Authorized Official

Authorized Official Last Name:
RAPADAS
Authorized Official First Name:
ROMEO
Authorized Official Middle Name:
PAZ
Authorized Official Title or Position:
CEO/ADMINISTRATOR
Authorized Official Telephone Number:
562-864-2627

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  550000964 , 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)

  • Identifier: 4980339 . This is a "MEDI-CAL PIN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com