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General NPI Number Information
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NPI Number | 1306909494
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Entity Type | Organization
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Legal Business Name | PRESTIGE MEDICAL MANAGEMENT INC.
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Dates
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Enumeration Date | 12/19/2006
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Last Update Date | 08/27/2009
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Provider Practice Location Address
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Address Line | 1980 N ORANGE GROVE AVE
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City | POMONA
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State | CA
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Zip | 91767-3008
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Country | US
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Telephone | 909-623-1517
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Fax | 909-623-1510
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Provider Business Mailing Address
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Address Line | 1980 N ORANGE GROVE AVE
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City | POMONA
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State | CA
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Zip | 91767-3008
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Country | US
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Telephone | 909-623-1517
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Fax | 909-623-1510
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Authorized Official
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Title or Position | MEDICAL DIRECTOR ANDPLASTIC SURGEON
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Name | DR. LIGORIO ARRELLANO CALAYCAY JR.
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Credential | M.D.
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Telephone | 909-623-1517
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | A25340
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License Number State | CA
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