Provider Demographics
NPI:1649970740
Name:INTEGRATED ALLIED MEDICAL GROUP
Entity type:Organization
Organization Name:INTEGRATED ALLIED MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:MAJALIA
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-528-2781
Mailing Address - Street 1:313 E PROVIDENCIA AVE APT F
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91502-2720
Mailing Address - Country:US
Mailing Address - Phone:323-528-2781
Mailing Address - Fax:
Practice Address - Street 1:313 E PROVIDENCIA AVE APT F
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91502-2720
Practice Address - Country:US
Practice Address - Phone:323-528-2781
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty