Prisma Care, A Medical Corporation | |
2648 Main St Suite #a Chula Vista CA 91911-4664 | |
(619) 575-5000 | |
(619) 575-5060 |
Full Name | Prisma Care, A Medical Corporation |
---|---|
Speciality | Internal Medicine |
Location | 2648 Main St, Chula Vista, California |
Authorized Official Name and Position | Jose R Lopez (PRESIDENT) |
Authorized Official Contact | 6195755000 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Prisma Care, A Medical Corporation 2648 Main St Suite #a Chula Vista CA 91911-4664 Ph: (619) 575-5000 | Prisma Care, A Medical Corporation 2648 Main St Suite #a Chula Vista CA 91911-4664 Ph: (619) 575-5000 |
NPI Number | 1093809139 |
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Provider Enumeration Date | 10/03/2006 |
Last Update Date | 07/15/2009 |
Medicare PECOS PAC ID | 1658423801 |
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Medicare Enrollment ID | O20090720000009 |
Identifier | Type | State | Issuer |
---|---|---|---|
1093809139 | NPI | - | NPPES |
00A433010 | Medicaid | CA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207R00000X | Internal Medicine | A43301 (California) | Primary |
Provider Name | Jose R Lopez |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1568667228 PECOS PAC ID: 9436191095 Enrollment ID: I20050524001361 |
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