Healthcare Provider Details

I. General information

NPI: 1053680074
Provider Name (Legal Business Name): PREFERRED PETCARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2011
Last Update Date: 12/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1736 SO. SEPULVEDA BLVD., SUITE D
LOS ANGELES CA
90025
US

IV. Provider business mailing address

1736 SO. SEPULVEDA BLVD. SUITE D
LOS ANGELES CA
90245
US

V. Phone/Fax

Practice location:
  • Phone: 310-478-0248
  • Fax: 310-473-0650
Mailing address:
  • Phone: 310-478-0248
  • Fax: 310-473-0650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License Number
License Number StateCA

VIII. Authorized Official

Name: MS. NURY J. GOMEZ
Title or Position: VICE PRESIDENT AND C.O.O.
Credential:
Phone: 310-478-0248