MEDICARE: PROHEALTH CARE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	44893	CA

General Provider Information

NPI Number	:	1407928054
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROHEALTH CARE, INC.

Provider Business Mailing Address
First Line	:	1590 OAKLAND RD
Second Line	:	B 105
City	:	SAN JOSE
State	:	CA
Zip	:	95131-2443
Country	:	US
Telephone Number	:	408-452-1658
Fax Number	:	408-452-7703

Provider Business Practice Location Address
First Line	:	1590 OAKLAND RD
Second Line	:	B 105
City	:	SAN JOSE
State	:	CA
Zip	:	95131-2443
Country	:	US
Telephone Number	:	408-452-1658
Fax Number	:	408-452-7703

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MALALAI MOHIDEEN
Credential	:
Telephone Number	:	408-452-1658

Provider Enumeration Date	:	11/15/2006
Last Update Date	:	08/22/2020

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