Healthcare Provider Details

I. General information

NPI: 1750521035
Provider Name (Legal Business Name): PROGEN AUTOTRANSFUSION/CORONARY SUPPORT SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2009
Last Update Date: 02/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2764 SAN FRANCISCO AVE
LONG BEACH CA
90806-2550
US

IV. Provider business mailing address

15333 CULVER DR SUITE 340-181
IRVINE CA
92604-3078
US

V. Phone/Fax

Practice location:
  • Phone: 949-464-9600
  • Fax: 562-424-5895
Mailing address:
  • Phone: 949-464-9600
  • Fax: 562-424-5895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name: MS. GEORGINA BELLMAR
Title or Position: CEO
Credential:
Phone: 949-464-9600