Healthcare Provider Details

I. General information

NPI: 1336260421
Provider Name (Legal Business Name): PROACTIVE WORK HEALTH MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1230 W 3RD ST
LOS ANGELES CA
90017-1408
US

IV. Provider business mailing address

1230 W 3RD ST
LOS ANGELES CA
90017-1408
US

V. Phone/Fax

Practice location:
  • Phone: 213-977-9300
  • Fax: 213-977-9600
Mailing address:
  • Phone: 213-977-9300
  • Fax: 213-977-9600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN R GREENE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 213-977-9300