Provider Demographics
NPI:1043453897
Name:PROSPICE MEDICAL CENTERS
Entity type:Organization
Organization Name:PROSPICE MEDICAL CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP/CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:RUTHI
Authorized Official - Middle Name:
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-825-6416
Mailing Address - Street 1:PO BOX 25551
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92799-5551
Mailing Address - Country:US
Mailing Address - Phone:949-825-6416
Mailing Address - Fax:951-537-6931
Practice Address - Street 1:14742 NEWPORT AVENUE
Practice Address - Street 2:SUITE 203
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-6177
Practice Address - Country:US
Practice Address - Phone:949-825-6416
Practice Address - Fax:951-537-6931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-09
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center