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General NPI Number Information
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NPI Number | 1548374937
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Entity Type | Organization
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Legal Business Name | PROCARE HEALTH CLINIC
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Dates
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Enumeration Date | 08/19/2006
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Last Update Date | 06/29/2016
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Provider Practice Location Address
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Address Line | 643 W 6TH ST
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City | SAN PEDRO
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State | CA
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Zip | 90731-2523
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Country | US
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Telephone | 310-548-5984
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Fax |
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Provider Business Mailing Address
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Address Line | 16563 MOUNT SHERROD CIR
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-2341
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Country | US
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Telephone | 310-612-3975
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Fax | 310-548-5050
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Authorized Official
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Title or Position | OWNER
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Name | DR. SON LAM NGUYEN
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Credential | D.C, L.AC
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Telephone | 310-612-3975
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC9007
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC27827
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License Number State | CA
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