Provider Demographics
NPI:1699926378
Name:PROACTIVE SENIOR CARE INC
Entity type:Organization
Organization Name:PROACTIVE SENIOR CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:GEMMA
Authorized Official - Middle Name:E
Authorized Official - Last Name:PORSUELO
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:619-887-2838
Mailing Address - Street 1:PO BOX 628
Mailing Address - Street 2:
Mailing Address - City:JULIAN
Mailing Address - State:CA
Mailing Address - Zip Code:92036-0628
Mailing Address - Country:US
Mailing Address - Phone:619-887-2838
Mailing Address - Fax:760-765-4684
Practice Address - Street 1:944 REGAL RD
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-4634
Practice Address - Country:US
Practice Address - Phone:619-887-2838
Practice Address - Fax:760-765-4684
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-01
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15158363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Single Specialty