Provider Demographics
NPI:1801805056
Name:INTEGRATED HEALTHCARE MEDICAL GROUP INC.
Entity type:Organization
Organization Name:INTEGRATED HEALTHCARE MEDICAL GROUP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:IFRAIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CONTRERAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-419-4303
Mailing Address - Street 1:1762 WESTWOOD BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-5641
Mailing Address - Country:US
Mailing Address - Phone:310-441-2000
Mailing Address - Fax:310-441-2020
Practice Address - Street 1:1762 WESTWOOD BLVD STE 300
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-5641
Practice Address - Country:US
Practice Address - Phone:310-441-2000
Practice Address - Fax:310-441-2020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA38857207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0085621Medicaid
CAGR0085620Medicaid
CAW14717AMedicare ID - Type Unspecified
CAGR0085620Medicaid
CAGR0085621Medicaid