MEDICARE: PROFESSIONAL HEALTHCARE ASSOCIATES, 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	3416L0300X	Land Ambulance

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ZZZ13518Z	OTHER	CA	BLUE SHIELD PROVIDER NUMBER

General Provider Information

NPI Number	:	1609912419
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROFESSIONAL HEALTHCARE ASSOCIATES, INC.

Provider Business Mailing Address
First Line	:	423 JENKS CIR
Second Line	:
City	:	CORONA
State	:	CA
Zip	:	92878-5039
Country	:	US
Telephone Number	:	951-278-3700
Fax Number	:	951-736-1933

Provider Business Practice Location Address
First Line	:	423 JENKS CIR
Second Line	:
City	:	CORONA
State	:	CA
Zip	:	92878-5039
Country	:	US
Telephone Number	:	951-278-3700
Fax Number	:	951-736-1933

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	DEBORAH RUIZ
Credential	:
Telephone Number	:	951-278-3700

Provider Enumeration Date	:	01/29/2007
Last Update Date	:	10/18/2024

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