Healthcare Provider Details

I. General information

NPI: 1356614937
Provider Name (Legal Business Name): PROSPICE PHYSICAL MEDICINE CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2012
Last Update Date: 03/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5630 E SANTA ANA CANYON RD STE. 150
ANAHEIM CA
92807-3126
US

IV. Provider business mailing address

5630 E SANTA ANA CANYON RD STE. 150
ANAHEIM CA
92807-3126
US

V. Phone/Fax

Practice location:
  • Phone: 714-476-2073
  • Fax: 951-537-6931
Mailing address:
  • Phone: 714-476-2073
  • Fax: 951-537-6931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License NumberC3420564
License Number StateCA

VIII. Authorized Official

Name: DR. RAMNIK SINGH
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 714-476-2073