Provider Demographics
NPI:1407928054
Name:PROHEALTH CARE, INC.
Entity Type:Organization
Organization Name:PROHEALTH CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MALALAI
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHIDEEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-452-1658
Mailing Address - Street 1:1590 OAKLAND RD
Mailing Address - Street 2:B 105
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95131-2443
Mailing Address - Country:US
Mailing Address - Phone:408-452-1658
Mailing Address - Fax:408-452-7703
Practice Address - Street 1:1590 OAKLAND RD
Practice Address - Street 2:B 105
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95131-2443
Practice Address - Country:US
Practice Address - Phone:408-452-1658
Practice Address - Fax:408-452-7703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44893332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5625030001Medicare NSC