Provider Demographics
NPI:1306909494
Name:PRESTIGE MEDICAL MANAGEMENT INC.
Entity type:Organization
Organization Name:PRESTIGE MEDICAL MANAGEMENT INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR ANDPLASTIC SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:LIGORIO
Authorized Official - Middle Name:ARRELLANO
Authorized Official - Last Name:CALAYCAY
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:909-623-1517
Mailing Address - Street 1:1980 N ORANGE GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-3008
Mailing Address - Country:US
Mailing Address - Phone:909-623-1517
Mailing Address - Fax:909-623-1510
Practice Address - Street 1:1980 N ORANGE GROVE AVE
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-3008
Practice Address - Country:US
Practice Address - Phone:909-623-1517
Practice Address - Fax:909-623-1510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA25340208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A253400Medicaid
CA00A253400Medicaid
CAW21085Medicare PIN