| Organization Name: | PROTOTYPES OUTPATIENT SERVICES |
| NPI Number: | 1174732515 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | VIVIAN B BROWN (CEO) |
| Mailing Address: | 831 E Arrow Hwy Pomona |
| State: | CA US |
| Postal Code: | 917672535 |
| Phone Number: | 9093984383 |
| Fax Number: | 9093980127 |
| NPI Enumeration Date: | 05/22/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 251K00000X |
| License Number: | 190101CN |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Agencies |
| Taxonomy Classification: | Public Health or Welfare |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |