Provider Demographics
NPI:1487167433
Name:PROGRESSIVE MEDICAL ASSOCIATES
Entity type:Organization
Organization Name:PROGRESSIVE MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEPE
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:213-305-9379
Mailing Address - Street 1:10436 DOWNEY AVE
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241-2514
Mailing Address - Country:US
Mailing Address - Phone:213-305-9379
Mailing Address - Fax:323-835-6950
Practice Address - Street 1:6611 SEVILLE AVENUE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90241
Practice Address - Country:US
Practice Address - Phone:323-835-6980
Practice Address - Fax:323-835-6950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-13
Last Update Date:2017-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA10791OtherCALIFORNIA DMHC