Provider Demographics
NPI:1649646209
Name:PRODE P. PASCUAL, M.D., INC.
Entity type:Organization
Organization Name:PRODE P. PASCUAL, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PRODE
Authorized Official - Middle Name:
Authorized Official - Last Name:PASCUAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-865-0213
Mailing Address - Street 1:18331 GRIDLEY RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-5438
Mailing Address - Country:US
Mailing Address - Phone:562-865-0213
Mailing Address - Fax:562-865-1050
Practice Address - Street 1:18331 GRIDLEY RD
Practice Address - Street 2:SUITE C
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-5438
Practice Address - Country:US
Practice Address - Phone:562-865-0213
Practice Address - Fax:562-865-1050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-18
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA30986261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A309860Medicaid
A30986OtherMEDICARE ID-TYPE UNSPECIFIED
CAA26303Medicare UPIN
CA00A309860Medicaid