Provider Demographics
NPI:1952327397
Name:COMPRE CARE MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:COMPRE CARE MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:AZUBIKE
Authorized Official - Last Name:OKONKWO AGUOLU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-753-7000
Mailing Address - Street 1:PO BOX 4444Y
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90044-0946
Mailing Address - Country:US
Mailing Address - Phone:323-753-7000
Mailing Address - Fax:323-753-2446
Practice Address - Street 1:8500 S FIGUEROA ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90003-2774
Practice Address - Country:US
Practice Address - Phone:323-753-7000
Practice Address - Fax:323-753-2446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA29427207Q00000X, 207R00000X, 2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA29427Medicaid
CAA83949Medicare UPIN
CAA29427Medicaid