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General NPI Number Information
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NPI Number | 1487167433
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Entity Type | Organization
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Legal Business Name | PROGRESSIVE MEDICAL ASSOCIATES
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Dates
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Enumeration Date | 11/13/2017
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Last Update Date | 11/13/2017
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Provider Practice Location Address
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Address Line | 6611 SEVILLE AVENUE
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City | HUNTINGTON PARK
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State | CA
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Zip | 90241
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Country | US
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Telephone | 323-835-6980
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Fax | 323-835-6950
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Provider Business Mailing Address
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Address Line | 10436 DOWNEY AVE
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City | DOWNEY
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State | CA
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Zip | 90241-2514
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Country | US
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Telephone | 213-305-9379
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Fax | 323-835-6950
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. JUAN LEPE
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Credential | MBA
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Telephone | 213-305-9379
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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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