Provider Demographics
NPI:1154583193
Name:CALIFORNIA PRIMARY HEALTH CARE CORP
Entity type:Organization
Organization Name:CALIFORNIA PRIMARY HEALTH CARE CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSALINDA
Authorized Official - Middle Name:VALMEO
Authorized Official - Last Name:PROTACIO
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:818-395-7311
Mailing Address - Street 1:710 S. CENTRAL AVENUE
Mailing Address - Street 2:SUITE 340
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-4647
Mailing Address - Country:US
Mailing Address - Phone:818-500-8739
Mailing Address - Fax:818-500-0957
Practice Address - Street 1:710 S. CENTRAL AVENUE
Practice Address - Street 2:SUITE 340
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-4647
Practice Address - Country:US
Practice Address - Phone:818-500-8739
Practice Address - Fax:818-500-0957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-01
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA049837Medicaid
CAA49837Medicare PIN
CAA049837Medicaid