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General NPI Number Information
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NPI Number | 1992545230
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Entity Type | Organization
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Legal Business Name | PROSPERA INTERNAL MEDICINE & AESTHETICS, INC.
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Dates
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Enumeration Date | 05/24/2024
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Last Update Date | 05/24/2024
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Provider Practice Location Address
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Address Line | 4452 PARK BLVD STE 306
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City | SAN DIEGO
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State | CA
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Zip | 92116-4049
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Country | US
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Telephone | 619-206-4232
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Fax | 833-972-5097
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Provider Business Mailing Address
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Address Line | 4452 PARK BLVD STE 306
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City | SAN DIEGO
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State | CA
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Zip | 92116-4049
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Country | US
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Telephone | 619-206-4232
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Fax | 833-972-5097
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Authorized Official
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Title or Position | OWNER, SECRETARY
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Name | LEA M PACE
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Credential | PA-C
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Telephone | 619-518-1061
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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