NPIMap

Organization Active NPI

California Primary Health Care Corp

  • Internal Medicine Physician
  • Glendale, CA
National Provider Identifier
1154583193
Registry record updated Sep 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
CALIFORNIA PRIMARY HEALTH CARE CORP
Practice address
710 S. Central Avenue
Suite 340
Glendale, CA 91204-4647
Phone
(818) 500-8739
Fax
(818) 500-0957
NPI assigned
Jul 1, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 21, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Rosalinda Valmeo Protacio, NPNPI 1124213186
Title
Office Manager
Phone
(818) 395-7311

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary
Hospice and Palliative Medicine (Internal Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RH0002X
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X
Primary Care Clinic/Center 261QP2300X

Addresses

Primary practice location

710 S. Central Avenue
Suite 340
Glendale, CA 91204-4647

Mailing address

710 S. Central Avenue
Suite 340
Glendale, CA 91204-4647
Phone (818) 500-8739

Other identifiers 1

IdentifierTypeStateIssuer
A049837MedicaidCA

Other names 1

  • Rodolfo B Protacio MD Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20081203000700 CA Part B Supplier - Clinic/Group Practice 7618038001 Receives reassigned benefits from 1 practitioner
Practice locations: Glendale, CA

National Provider Directory

National Provider Directory

Locations

710 S Central Ave
Ste 330
Glendale, CA 91204
Phone (818) 263-5737

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1214870400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1695254400000",
    "number": "1154583193",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "710 S. CENTRAL AVENUE",
            "address_2": "SUITE 340",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912044647",
            "telephone_number": "818-500-8739",
            "fax_number": "818-500-0957"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "710 S. CENTRAL AVENUE",
            "address_2": "SUITE 340",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912044647",
            "telephone_number": "818-500-8739",
            "fax_number": "818-500-0957"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CALIFORNIA PRIMARY HEALTH CARE CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-01",
        "last_updated": "2023-09-21",
        "certification_date": "2020-04-08",
        "status": "A",
        "authorized_official_last_name": "PROTACIO",
        "authorized_official_first_name": "ROSALINDA",
        "authorized_official_middle_name": "VALMEO",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "818-395-7311",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207RH0002X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Hospice and Palliative Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "A049837",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Rodolfo B Protacio MD",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Glendale, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.