MEDICARE: ERNEST PROCHAZKA

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	2083X0100X	Occupational Medicine Physician	C51296	CA

General Provider Information

NPI Number	:	1881872489
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERNEST PROCHAZKA

Provider Business Mailing Address
First Line	:	6147 E HUNTDALE ST
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90808-2937
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6147 E HUNTDALE ST
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90808-2937
Country	:	US
Telephone Number	:	361-537-3576
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2008
Last Update Date	:	02/06/2008

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Directions to “ ERNEST PROCHAZKA ” Practice Location

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