Provider Demographics
NPI:1780026328
Name:UPTIMUM CARE MEDICAL GROUP &IPA INC
Entity Type:Organization
Organization Name:UPTIMUM CARE MEDICAL GROUP &IPA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:OLUKEMI
Authorized Official - Middle Name:A
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-644-8400
Mailing Address - Street 1:2220 W MANCHESTER BLVD
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90305-2514
Mailing Address - Country:US
Mailing Address - Phone:310-644-8400
Mailing Address - Fax:310-644-8424
Practice Address - Street 1:15342 HAWTHORNE BLVD
Practice Address - Street 2:STE 102
Practice Address - City:LAWNDALE
Practice Address - State:CA
Practice Address - Zip Code:90260-2152
Practice Address - Country:US
Practice Address - Phone:310-644-8400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA48240261QM1300X
CA23055282N00000X, 302R00000X, 305R00000X, 305S00000X, 3104A0630X, 320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No282N00000XHospitalsGeneral Acute Care Hospital
No302R00000XManaged Care OrganizationsHealth Maintenance Organization
No305S00000XManaged Care OrganizationsPoint of Service
No3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities