Provider Demographics
NPI:1346607603
Name:UNIFIED CARE MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:UNIFIED CARE MEDICAL GROUP, INC.
Other - Org Name:UNIFIED CARE MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:RODERICK
Authorized Official - Middle Name:P
Authorized Official - Last Name:RAMOS
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:424-347-8008
Mailing Address - Street 1:2040 PACIFIC COAST HWY
Mailing Address - Street 2:SUITE S
Mailing Address - City:LOMITA
Mailing Address - State:CA
Mailing Address - Zip Code:90717-2660
Mailing Address - Country:US
Mailing Address - Phone:424-347-8008
Mailing Address - Fax:
Practice Address - Street 1:2040 PACIFIC COAST HWY
Practice Address - Street 2:SUITE S
Practice Address - City:LOMITA
Practice Address - State:CA
Practice Address - Zip Code:90717-2660
Practice Address - Country:US
Practice Address - Phone:424-347-8008
Practice Address - Fax:844-481-9664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-18
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QP2300X
CAPA19706261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA25005OtherMANUEL BACULI MD
CAPA19706OtherRODERICK P RAMOS
CAA25005OtherMANUEL BACULI MD