Organization
PROSPERA GROUP CORP
Active
Organization
PROSPERA GROUP CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RENA KEYNIGSHTEYN MD (PRESIDENT)
(310) 204-6897
Entity
Organization
Contact information
Practice address
3831 HUGHES AVE, SUITE 602, CULVER CITY, CA 90232-2751
(310) 204-6897
(310) 204-4690
Mailing address
3831 HUGHES AVE, SUITE 602, CULVER CITY, CA 90232-2751
(310) 204-6897
(310) 204-4690
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1285711937
MEDI-CAL
CA
05
—
1285711937
—
CA
Enumeration date
11/01/2006
Last updated
09/26/2013
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