Provider Demographics
NPI:1972623205
Name:PROKOP, MARC
Entity type:Individual
Prefix:MR
First Name:MARC
Middle Name:
Last Name:PROKOP
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10932 CARMENITA RD
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90605-3238
Mailing Address - Country:US
Mailing Address - Phone:562-941-5249
Mailing Address - Fax:
Practice Address - Street 1:6055 EAST WASHINGTON BLVD
Practice Address - Street 2:900
Practice Address - City:CITY OF COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90040
Practice Address - Country:US
Practice Address - Phone:323-346-0960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner