Provider Demographics
NPI:1811042351
Name:SOUTHERN CALIFORNIA IMMEDIATE MEDICAL CENTER
Entity Type:Organization
Organization Name:SOUTHERN CALIFORNIA IMMEDIATE MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:ROCCAPALUMBO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:323-726-3212
Mailing Address - Street 1:7300 ALONDRA BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:PARAMOUNT
Mailing Address - State:CA
Mailing Address - Zip Code:90723-4000
Mailing Address - Country:US
Mailing Address - Phone:562-531-8300
Mailing Address - Fax:562-531-8035
Practice Address - Street 1:5203 LAKEWOOD BLVD
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712-2415
Practice Address - Country:US
Practice Address - Phone:562-633-2273
Practice Address - Fax:562-633-1796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty