Healthcare Provider Details

I. General information

NPI: 1902659733
Provider Name (Legal Business Name): PRIME MDCARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2024
Last Update Date: 04/10/2024
Certification Date: 04/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20430 STARSHINE RD
WALNUT CA
91789-3539
US

IV. Provider business mailing address

20430 STARSHINE RD
WALNUT CA
91789-3539
US

V. Phone/Fax

Practice location:
  • Phone: 310-910-7329
  • Fax: 310-388-0126
Mailing address:
  • Phone: 310-910-7329
  • Fax: 310-388-0126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. PRODE P PASCUAL
Title or Position: PRESIDENT/CEO
Credential: MD
Phone: 310-910-7329