Healthcare Provider Details

I. General information

NPI: 1144268327
Provider Name (Legal Business Name): PROGRESSIVE HEALTH AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 04/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 E MAIN ST SUITE 102
EL CAJON CA
92020-3909
US

IV. Provider business mailing address

P.O. BOX 511588
LOS ANGELES CA
90051-8143
US

V. Phone/Fax

Practice location:
  • Phone: 619-631-0128
  • Fax: 619-631-0153
Mailing address:
  • Phone: 866-284-2771
  • Fax: 800-334-1041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. PRAKASH K. BHATIA
Title or Position: PRESIDENT
Credential: MD
Phone: 619-631-0128