MEDICARE: PRIME HEALTHCARE CA, PC

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	208600000X	Surgery Physician

General Provider Information

NPI Number	:	1689543852
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIME HEALTHCARE CA, PC

Provider Business Mailing Address
First Line	:	6300 WILSHIRE BLVD STE 980
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-5202
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6300 WILSHIRE BLVD STE 980
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-5202
Country	:	US
Telephone Number	:	917-732-6379
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	OREN RAPHAEL
Credential	:
Telephone Number	:	917-732-6379

Provider Enumeration Date	:	11/04/2025
Last Update Date	:	11/04/2025

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