Provider Demographics
NPI:1629143821
Name:IMMEDIATE FAMILY MEDICAL CARE NORTH
Entity Type:Organization
Organization Name:IMMEDIATE FAMILY MEDICAL CARE NORTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:M
Authorized Official - Last Name:OKUN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-565-1300
Mailing Address - Street 1:P.O. BOX 50042
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-0042
Mailing Address - Country:US
Mailing Address - Phone:661-678-2300
Mailing Address - Fax:
Practice Address - Street 1:25285 MADISON AVENUE
Practice Address - Street 2:SUITE 101
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-8293
Practice Address - Country:US
Practice Address - Phone:951-600-9070
Practice Address - Fax:951-600-9177
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:U.S. HEALTHWORKS MEDICAL GROUP, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-22
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Multi-Specialty
No2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ27081ZMedicare ID - Type Unspecified
CAZZZ27081ZMedicare PIN