Provider Demographics
NPI:1407291347
Name:EXECUTIVE MEDICINE, INC.
Entity Type:Organization
Organization Name:EXECUTIVE MEDICINE, INC.
Other - Org Name:MONROVIA INTERNAL MEDICINE AND PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ULIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SARGEANT
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MPH
Authorized Official - Phone:877-254-4496
Mailing Address - Street 1:PO BOX 2063
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91017-6063
Mailing Address - Country:US
Mailing Address - Phone:877-254-4496
Mailing Address - Fax:877-254-4496
Practice Address - Street 1:1227 BUENA VISTA ST
Practice Address - Street 2:SUITE #F
Practice Address - City:DUARTE
Practice Address - State:CA
Practice Address - Zip Code:91010-2486
Practice Address - Country:US
Practice Address - Phone:877-254-4496
Practice Address - Fax:877-254-4496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-06
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA97256207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty