Provider Demographics
NPI:1205041290
Name:SOUTHERN CALIFORNIA IMMEDIATE MEDICAL CENTER
Entity Type:Organization
Organization Name:SOUTHERN CALIFORNIA IMMEDIATE MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:THONAS
Authorized Official - Middle Name:
Authorized Official - Last Name:ROCCAPALUMBO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:323-726-3212
Mailing Address - Street 1:7300 ALONDRA BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:PARAMOUNT
Mailing Address - State:CA
Mailing Address - Zip Code:90723-4000
Mailing Address - Country:US
Mailing Address - Phone:562-531-8300
Mailing Address - Fax:562-531-8035
Practice Address - Street 1:15330 VALLEY VIEW AVE STE 1
Practice Address - Street 2:
Practice Address - City:LA MIRADA
Practice Address - State:CA
Practice Address - Zip Code:90638-5238
Practice Address - Country:US
Practice Address - Phone:562-802-0208
Practice Address - Fax:562-802-0999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20 A5386174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty