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General NPI Number Information
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NPI Number | 1215255583
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Entity Type | Organization
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Legal Business Name | PRESTIGE CARE PHYSICIAN, INC
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Dates
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Enumeration Date | 05/12/2010
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Last Update Date | 03/17/2023
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Provider Practice Location Address
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Address Line | 23600 TELO AVE SUITE 145
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City | TORRANCE
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State | CA
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Zip | 90505-4035
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Country | US
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Telephone | 310-325-9009
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Fax | 310-325-4938
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Provider Business Mailing Address
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Address Line | 23600 TELO AVE SUITE 145
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City | TORRANCE
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State | CA
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Zip | 90505-4035
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Country | US
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Telephone | 310-325-9009
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Fax | 310-325-4938
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Authorized Official
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Title or Position | MANAGER
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Name | MRS. LALAINE CHIN
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Credential |
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Telephone | 310-325-3084
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A42582
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License Number State | CA
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