Healthcare Provider Details

I. General information

NPI: 1942406780
Provider Name (Legal Business Name): PROTOTYPES WOMENS CENTER OUTPATIENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6339 MANUEL CT
CHINO CA
91710-4628
US

IV. Provider business mailing address

6339 MANUEL CT
CHINO CA
91710-4628
US

V. Phone/Fax

Practice location:
  • Phone: 909-591-7251
  • Fax:
Mailing address:
  • Phone: 909-591-7251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. KIM A FRANKLIN
Title or Position: COUNSELORCASEMANAGER
Credential:
Phone: 909-591-7251