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General NPI Number Information
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NPI Number | 1184041980
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Entity Type | Organization
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Legal Business Name | PREVENTIVE CARE SOLUTIONS INC
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Dates
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Enumeration Date | 03/18/2014
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Last Update Date | 03/18/2014
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Provider Practice Location Address
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Address Line | 1565 MENDOCINO DR UNIT 160
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City | CHULA VISTA
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State | CA
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Zip | 91911-6052
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Country | US
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Telephone | 619-208-6318
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Fax | 619-337-0956
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Provider Business Mailing Address
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Address Line | 1565 MENDOCINO DR UNIT 160
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City | CHULA VISTA
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State | CA
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Zip | 91911-6052
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Country | US
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Telephone | 619-208-6318
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Fax | 619-337-0956
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Authorized Official
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Title or Position | CFO
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Name | FERNANDA CEBALLOS
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Credential |
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Telephone | 619-208-6318
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | BS2014005590
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License Number State | CA
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