MEDICARE: PROFESSIONAL MANAGEMENT SERVICES, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1538720842
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROFESSIONAL MANAGEMENT SERVICES, INC

Provider Business Mailing Address
First Line	:	3811 EL CAJON BLVD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92105-1020
Country	:	US
Telephone Number	:	619-284-5622
Fax Number	:	619-283-2572

Provider Business Practice Location Address
First Line	:	3811 EL CAJON BLVD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92105-1020
Country	:	US
Telephone Number	:	619-284-5622
Fax Number	:	619-283-2572

Authorized Official
Title or Position	:	OWNER / PRESIDENT
Name	:	ALBERTO PERALTA
Credential	:
Telephone Number	:	619-284-5622

Provider Enumeration Date	:	06/26/2019
Last Update Date	:	06/26/2019

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