Provider Demographics
NPI:1790412252
Name:INFUCARE MEDICAL GROUP OF CALIFORNIA INC
Entity Type:Organization
Organization Name:INFUCARE MEDICAL GROUP OF CALIFORNIA INC
Other - Org Name:CLINIVOY INFUSION CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GENEVIEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:BENJAMIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-783-7009
Mailing Address - Street 1:16782 VON KARMAN AVE STE 12
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606-2417
Mailing Address - Country:US
Mailing Address - Phone:858-314-9222
Mailing Address - Fax:949-864-2320
Practice Address - Street 1:4065 WHITTIER BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90023-2556
Practice Address - Country:US
Practice Address - Phone:858-314-9222
Practice Address - Fax:949-864-2320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-04
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy