Provider Demographics
NPI:1548973951
Name:PROSPERITE HEALTH
Entity type:Organization
Organization Name:PROSPERITE HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO & PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:VON INS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-924-3404
Mailing Address - Street 1:300 E YORBA LINDA BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-2910
Mailing Address - Country:US
Mailing Address - Phone:714-924-3404
Mailing Address - Fax:714-364-1091
Practice Address - Street 1:300 E YORBA LINDA BLVD STE B
Practice Address - Street 2:
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-2910
Practice Address - Country:US
Practice Address - Phone:714-924-3404
Practice Address - Fax:714-364-1091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-30
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care