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General NPI Number Information
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NPI Number | 1902203441
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Entity Type | Organization
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Legal Business Name | PROACTIVE NURSING, INC.
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Dates
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Enumeration Date | 11/27/2014
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Last Update Date | 11/27/2014
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Provider Practice Location Address
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Address Line | 8692 WAGERS CIR
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92647-5027
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Country | US
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Telephone | 619-887-2838
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Fax |
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Provider Business Mailing Address
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Address Line | 2345 E 8TH ST STE 102
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City | NATIONAL CITY
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State | CA
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Zip | 91950-2868
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Country | US
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Telephone | 619-887-2838
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Fax |
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Authorized Official
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Title or Position | COO
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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 |
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License Number State | CA
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