Provider Demographics
NPI:1225228703
Name:PROLIFIC HEALTH CARE, INC.
Entity Type:Organization
Organization Name:PROLIFIC HEALTH CARE, INC.
Other - Org Name:PROLIFIC HEALTH CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROMEO
Authorized Official - Middle Name:PAZ
Authorized Official - Last Name:RAPADAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-864-2627
Mailing Address - Street 1:12631 IMPERIAL HWY
Mailing Address - Street 2:SUITE C-105
Mailing Address - City:SANTA FE SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:90670-4710
Mailing Address - Country:US
Mailing Address - Phone:562-864-2627
Mailing Address - Fax:562-864-2757
Practice Address - Street 1:12631 IMPERIAL HWY
Practice Address - Street 2:SUITE C-105
Practice Address - City:SANTA FE SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:90670-4710
Practice Address - Country:US
Practice Address - Phone:562-864-2627
Practice Address - Fax:562-864-2757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-31
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550000964251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4980339OtherMEDI-CAL PIN
CA059128Medicare Oscar/Certification