MEDICARE: PROTOTYPES WOMENS CENTER OUTPATIENT

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	3245S0500X	Children's Substance Abuse Rehabilitation Facility
2	320800000X	Mental Illness Community Based Residential Treatment Facility		CA

General Provider Information

NPI Number	:	1942406780
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROTOTYPES WOMENS CENTER OUTPATIENT

Provider Business Mailing Address
First Line	:	6339 MANUEL CT
Second Line	:
City	:	CHINO
State	:	CA
Zip	:	91710-4628
Country	:	US
Telephone Number	:	909-591-7251
Fax Number	:

Provider Business Practice Location Address
First Line	:	6339 MANUEL CT
Second Line	:
City	:	CHINO
State	:	CA
Zip	:	91710-4628
Country	:	US
Telephone Number	:	909-591-7251
Fax Number	:

Authorized Official
Title or Position	:	COUNSELORCASEMANAGER
Name	:	MS. KIM A FRANKLIN
Credential	:
Telephone Number	:	909-591-7251

Provider Enumeration Date	:	06/26/2007
Last Update Date	:	09/11/2025

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