| Prestige Care Physician, Inc | |
|
23600 Telo Ave Suite 145 Torrance CA 90505-4035 | |
| (310) 325-9009 | |
| (310) 325-4938 |
| Full Name | Prestige Care Physician, Inc |
|---|---|
| Speciality | Internal Medicine |
| Location | 23600 Telo Ave, Torrance, California |
| Authorized Official Name and Position | Lalaine Chin (MANAGER) |
| Authorized Official Contact | 3103253084 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Prestige Care Physician, Inc 23600 Telo Ave Suite 145 Torrance CA 90505-4035 Ph: (310) 325-9009 | Prestige Care Physician, Inc 23600 Telo Ave Suite 145 Torrance CA 90505-4035 Ph: (310) 325-9009 |
| NPI Number | 1215255583 |
|---|---|
| Provider Enumeration Date | 05/12/2010 |
| Last Update Date | 03/17/2023 |
| Medicare PECOS PAC ID | 5698955672 |
|---|---|
| Medicare Enrollment ID | O20110208000747 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215255583 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | A42582 (California) | Primary |
| Provider Name | Hicham Siouty |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1801831904 PECOS PAC ID: 7911919469 Enrollment ID: I20060626000314 |
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