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General NPI Number Information
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NPI Number | 1699926378
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Entity Type | Organization
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Legal Business Name | PROACTIVE SENIOR CARE INC
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Dates
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Enumeration Date | 10/01/2008
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Last Update Date | 10/01/2008
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Provider Practice Location Address
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Address Line | 944 REGAL RD
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City | ENCINITAS
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State | CA
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Zip | 92024-4634
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Country | US
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Telephone | 619-887-2838
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Fax | 760-765-4684
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Provider Business Mailing Address
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Address Line | PO BOX 628
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City | JULIAN
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State | CA
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Zip | 92036-0628
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Country | US
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Telephone | 619-887-2838
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Fax | 760-765-4684
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. GEMMA E. PORSUELO
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Credential | NURSE PRACTITIONER
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Telephone | 619-887-2838
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 15158
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License Number State | CA
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