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General NPI Number Information
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NPI Number | 1043331614
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Entity Type | Organization
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Legal Business Name | PROSPECT PROFESSIONAL CARE MEDICAL GROUP, INC.
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 02/27/2009
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Provider Practice Location Address
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Address Line | 1920 E 17TH ST SUITE 200
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City | SANTA ANA
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State | CA
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Zip | 92705-8626
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Country | US
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Telephone | 714-796-5900
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Fax |
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Provider Business Mailing Address
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Address Line | 1920 E 17TH ST SUITE 200
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City | SANTA ANA
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State | CA
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Zip | 92705-8626
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Country | US
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Telephone | 714-796-5900
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | LILY KAM
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Credential |
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Telephone | 714-796-5900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number |
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License Number State |
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