Provider Demographics
NPI:1821599804
Name:JOSE DALPRAT A PROFESSIONAL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:JOSE DALPRAT A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:REJUVENATE WELLNESS AND HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT AND SECRETARY,
Authorized Official - Prefix:
Authorized Official - First Name:REBECA
Authorized Official - Middle Name:E
Authorized Official - Last Name:CUATRO
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:323-507-2311
Mailing Address - Street 1:6025 N FIGUEROA ST STE B
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90042-1365
Mailing Address - Country:US
Mailing Address - Phone:323-507-2311
Mailing Address - Fax:323-621-6188
Practice Address - Street 1:6025 N FIGUEROA ST STE B
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90042-1365
Practice Address - Country:US
Practice Address - Phone:323-507-2311
Practice Address - Fax:323-621-6188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-23
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A11851207Q00000X
CA22666363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty