| Prospera Group Corp | |
|
3831 Hughes Ave Suite 602 Culver City CA 90232-2751 | |
| (310) 204-6897 | |
| (310) 204-4690 |
| Full Name | Prospera Group Corp |
|---|---|
| Speciality | Clinic/center - Multi-specialty |
| Location | 3831 Hughes Ave, Culver City, California |
| Authorized Official Name and Position | Rena Keynigshteyn (PRESIDENT) |
| Authorized Official Contact | 3102046897 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Prospera Group Corp 3831 Hughes Ave Suite 602 Culver City CA 90232-2751 Ph: (310) 204-6897 | Prospera Group Corp 3831 Hughes Ave Suite 602 Culver City CA 90232-2751 Ph: (310) 204-6897 |
| NPI Number | 1285711937 |
|---|---|
| Provider Enumeration Date | 11/01/2006 |
| Last Update Date | 09/26/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285711937 | NPI | - | NPPES |
| 1285711937 | Medicaid | CA | |
| 1285711937 | Other | CA | MEDI-CAL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
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