NPIMap

Organization Active NPI

Prode P. Pascual, M.D., Inc.

  • Primary Care Clinic/Center
  • Cerritos, CA
National Provider Identifier
1649646209
Registry record updated Aug 18, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
A30986 Issued in CA
Legal business name
PRODE P. PASCUAL, M.D., INC.
Practice address
18331 Gridley Rd
Suite C
Cerritos, CA 90703-5438
Phone
(562) 865-0213
Fax
(562) 865-1050
NPI assigned
Aug 18, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 18, 2015

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

Authorized official

Name
Prode PascualNPI 1558454595
Title
Ceo
Phone
(562) 865-0213

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X A30986 CA Primary

Addresses

Primary practice location

18331 Gridley Rd
Suite C
Cerritos, CA 90703-5438

Mailing address

18331 Gridley Rd
Suite C
Cerritos, CA 90703-5438
Phone (562) 865-0213

Other identifiers 2

IdentifierTypeStateIssuer
00A309860MedicaidCA
A30986OtherMEDICARE ID-TYPE UNSPECIFIED

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20151014000620 CA Part B Supplier - Clinic/Group Practice 8224347232 Receives reassigned benefits from 4 practitioners
Practice locations: Walnut, CA

National Provider Directory

National Provider Directory

Locations

4333 Torrance Blvd
Torrance, CA 90503
Phone (310) 370-4561

Practitioners & affiliated clinicians

Practitioners 5

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": "1439856000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1439856000000",
    "number": "1649646209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18331 GRIDLEY RD",
            "address_2": "SUITE C",
            "city": "CERRITOS",
            "state": "CA",
            "postal_code": "907035438",
            "telephone_number": "562-865-0213",
            "fax_number": "562-865-1050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18331 GRIDLEY RD",
            "address_2": "SUITE C",
            "city": "CERRITOS",
            "state": "CA",
            "postal_code": "907035438",
            "telephone_number": "562-865-0213",
            "fax_number": "562-865-1050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRODE P. PASCUAL, M.D., INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-18",
        "last_updated": "2015-08-18",
        "status": "A",
        "authorized_official_last_name": "PASCUAL",
        "authorized_official_first_name": "PRODE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "562-865-0213"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "CA",
            "license": "A30986",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A309860",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID-TYPE UNSPECIFIED",
            "identifier": "A30986",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cerritos, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2015; 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.