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General NPI Number Information
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NPI Number | 1700525334
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Entity Type | Organization
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Legal Business Name | PROACTIVE CARE PARTNERS OF CALIFORNIA PC
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Dates
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Enumeration Date | 06/01/2022
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Last Update Date | 06/11/2025
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Provider Practice Location Address
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Address Line | 111 N MARKET ST STE 379
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City | SAN JOSE
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State | CA
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Zip | 95113-1101
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Country | US
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Telephone | 561-568-5440
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Fax |
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Provider Business Mailing Address
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Address Line | 222 LAKEVIEW AVE STE 735
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City | WEST PALM BEACH
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State | FL
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Zip | 33401-6145
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Country | US
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Telephone | 231-432-5841
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Fax |
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Authorized Official
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Title or Position | PROVIDER NETWORK MANAGER
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Name | ELLA EDKINS
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Credential |
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Telephone | 480-619-8285
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number |
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License Number State |
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