| NPI | 1477113249 |
|---|---|
| Former Legal Business Name | PROSPECT CCMC, LLC |
| Entity Type | Organization |
| Authorized Contact | ROBERT JON ELDERS Secretary 714-788-1249 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Enumeration Date | 2019-06-14 |
| Last Update Date | 2021-01-15 |