Provider Demographics
NPI:1144268327
Name:PROGRESSIVE HEALTH AND WELLNESS
Entity type:Organization
Organization Name:PROGRESSIVE HEALTH AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PRAKASH
Authorized Official - Middle Name:K
Authorized Official - Last Name:BHATIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-631-0128
Mailing Address - Street 1:P.O. BOX 511588
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90051-8143
Mailing Address - Country:US
Mailing Address - Phone:866-284-2771
Mailing Address - Fax:800-334-1041
Practice Address - Street 1:161 E MAIN ST
Practice Address - Street 2:SUITE 102
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-3909
Practice Address - Country:US
Practice Address - Phone:619-631-0128
Practice Address - Fax:619-631-0153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA74848BMedicare UPIN