Provider Demographics
NPI:1588949275
Name:PERSUE HEALTH PARTNERSHIP
Entity type:Organization
Organization Name:PERSUE HEALTH PARTNERSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNERSHIP
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:714-754-8200
Mailing Address - Street 1:2740 S BRISTOL ST
Mailing Address - Street 2:218 203
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-6209
Mailing Address - Country:US
Mailing Address - Phone:714-754-8200
Mailing Address - Fax:714-754-8201
Practice Address - Street 1:2740 S BRISTOL ST
Practice Address - Street 2:218 203
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-6209
Practice Address - Country:US
Practice Address - Phone:714-754-8200
Practice Address - Fax:714-754-8201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-13
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1982928412Medicaid
CA1982928412Medicaid