Organization
PROACTIVE SENIOR CARE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. GEMMA E. PORSUELO NURSE PRACTITIONER (PRESIDENT)
(619) 887-2838
Entity
Organization
Contact information
Practice address
944 REGAL RD, ENCINITAS, CA 92024-4634
(619) 887-2838
(760) 765-4684
Mailing address
PO BOX 628, JULIAN, CA 92036-0628
(619) 887-2838
(760) 765-4684
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
15158
CA
Other
Enumeration date
10/01/2008
Last updated
10/01/2008
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