Organization
PROPHETE MEDICAL CORPORATION
Active
Other names
Liautaud Morin Prophete
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LIAUTAUD MORIN PROPHETE SR. D.O. (PRESIDENT)
(209) 826-4771
Entity
Organization
Contact information
Practice address
502 WASHINGTON AVE, LOS BANOS, CA 93635-4649
(209) 826-4771
(209) 826-8565
Mailing address
PO BOX 2236, LOS BANOS, CA 93635-2236
(209) 826-4771
(209) 826-8565
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
20A9842
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00AX98420
—
CA
Enumeration date
09/18/2007
Last updated
03/25/2019
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