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General NPI Number Information
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NPI Number | 1548973951
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Entity Type | Organization
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Legal Business Name | PROSPERITE HEALTH
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Dates
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Enumeration Date | 12/30/2022
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Last Update Date | 08/17/2023
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Provider Practice Location Address
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Address Line | 300 E YORBA LINDA BLVD STE B
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City | PLACENTIA
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State | CA
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Zip | 92870-2910
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Country | US
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Telephone | 714-924-3404
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Fax | 714-364-1091
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Provider Business Mailing Address
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Address Line | 300 E YORBA LINDA BLVD STE B
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City | PLACENTIA
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State | CA
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Zip | 92870-2910
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Country | US
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Telephone | 714-924-3404
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Fax | 714-364-1091
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Authorized Official
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Title or Position | CEO & PHYSICIAN
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Name | DR. SAMANTHA VON INS
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Credential | MD
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Telephone | 714-924-3404
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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