Provider Demographics
NPI:1134386667
Name:PREFERRED PHYSICIAN PROVIDERS INC
Entity type:Organization
Organization Name:PREFERRED PHYSICIAN PROVIDERS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:PRENTICE
Authorized Official - Last Name:NICKELL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:310-783-7450
Mailing Address - Street 1:381 VAN NESS AVE
Mailing Address - Street 2:SUITE 1507
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501-6224
Mailing Address - Country:US
Mailing Address - Phone:310-783-7450
Mailing Address - Fax:310-347-4188
Practice Address - Street 1:381 VAN NESS AVE
Practice Address - Street 2:SUITE 1507
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90501-6224
Practice Address - Country:US
Practice Address - Phone:310-783-7450
Practice Address - Fax:310-347-4188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization