Provider Demographics
NPI:1407368236
Name:INTEL MEDICAL GROUP INC
Entity Type:Organization
Organization Name:INTEL MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:NIMFA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMBULAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-860-6310
Mailing Address - Street 1:20301 VENTURA BLVD STE 352
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-2472
Mailing Address - Country:US
Mailing Address - Phone:818-860-6310
Mailing Address - Fax:818-860-6310
Practice Address - Street 1:20301 VENTURA BLVD STE 352
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-2472
Practice Address - Country:US
Practice Address - Phone:818-860-6310
Practice Address - Fax:818-860-6310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-02
Last Update Date:2017-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty