Healthcare Provider Details

I. General information

NPI: 1154583193
Provider Name (Legal Business Name): CALIFORNIA PRIMARY HEALTH CARE CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2008
Last Update Date: 09/21/2023
Certification Date: 04/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 S. CENTRAL AVENUE SUITE 340
GLENDALE CA
91204-4647
US

IV. Provider business mailing address

710 S. CENTRAL AVENUE SUITE 340
GLENDALE CA
91204-4647
US

V. Phone/Fax

Practice location:
  • Phone: 818-500-8739
  • Fax: 818-500-0957
Mailing address:
  • Phone: 818-500-8739
  • Fax: 818-500-0957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. ROSALINDA VALMEO PROTACIO
Title or Position: OFFICE MANAGER
Credential: NP
Phone: 818-395-7311