INTEGRATED MEDICAL GROUP INC (NPI# 1871931741) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1871931741 |
| Entity Type | Organization |
| Organization Name | INTEGRATED MEDICAL GROUP INC |
| Practice Address |
208 E Carson St Ste 101 Carson CA 90745-2762 |
| Mailing Address |
8622 Reseda Blvd Ste 200 Northridge CA 91324-4091 |
| Practice Telephone | 8182249390 |
| Practice Fax Number | 8189381538 |
| Mailing Telephone | 8182249390 |
| Mailing Fax Number | 8189381538 |
| Enumeration Date | 2013-06-12 |
| Last Update Date | 2016-06-19 |
| Authorized Official Name | MR. CHARLES SIMBULAN (CEO) |
| Authorized Official Telephone | 8182249390 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LP2300X |
Nurse Practitioner Specialization: Primary Care |
C3565047 | CA | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205182292 | Integrated Medical Group Inc | General Practice | 3230 S Buffalo Dr Ste 105, Las Vegas, NV 89117-2506 | 2012-07-27 |
| Street Address |
208 E CARSON ST STE 101 |
| City | CARSON |
| State | CA |
| Zip Code | 90745-2762 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336787696 | Michael Yoshio Sujishi | Technician/Technologist | 150 West Carson Street, Store 8839, Carson, CA 90745 | 2019-12-18 |
| 1891269262 | Cesar Carrasco Dds Inc | Dentist | 21847 S Avalon Blvd, Carson, CA 90745 | 2019-01-18 |
| 1427557305 | Stephanie Yunjung Ha | Nurse Practitioner | 23517 S. Main St., Carson, CA 90745 | 2018-02-06 |
| 1861911125 | Maria C Aluning | Dentist | 242 W. Carson St., Carson, CA 90745 | 2017-09-18 |
| 1144676024 | Omid Barkhordar Dental Corporation | Dentist | 101 West Carson Street, Carson, CA 90745 | 2016-05-10 |
| 1255720652 | Sandy Mauricio | Physical Therapy Assistant | 1804 E 215th St, Carson, CA 90745 | 2015-01-22 |
| 1275948994 | United Urgent Care and Wellness Center, Inc. | Clinic/Center | 522 West Carson Street, Carson, CA 90745 | 2014-06-23 |
| 1184052805 | Jumana B Hanna | Pharmacist | 500 Carson Town Center Kmart 4987 Pharmacy, Carson, CA 90745 | 2013-10-15 |
| 1679912422 | David J Chon | Dentist | 612 E Carson St #101, Carson, CA 90745 | 2013-06-14 |
| 1942644133 | Seema M Dave | Optometrist | 150 W Carson Street, Cvs Optical, Carson, CA 90745 | 2013-04-18 |
| Find all providers in zip 90745 | ||||
| Taxonomy Code | 363LP2300X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Primary Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245757699 | Jaimie T Abraham | Nurse Practitioner | 522 W Carson St, Carson, CA 90745-2635 | 2017-08-26 |
| 1093259558 | Leslie Ann Reyes Espe | Nurse Practitioner | 1000 E Dominguez St, Suite 110, Carson, CA 90746-3600 | 2016-12-16 |
| 1750710950 | Lilian Nkiru Ndukwe | Nurse Practitioner | 454 E Carson Plaza Dr, Suite 209, Carson, CA 90746-3209 | 2013-11-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235738782 | Peninsula Healthcare Center | Nurse Practitioner | 22330 Hawthorne Blvd Ste 208, Torrance, CA 90505-2536 | 2020-10-25 |
| 1710584008 | Venessa Beck | Nurse Practitioner | 903 Cardiff St, San Diego, CA 92114-5019 | 2020-10-08 |
| 1053918094 | Janel Nicole Sanglerat | Nurse Practitioner | 416 Aviation Blvd, Santa Rosa, CA 95403-1032 | 2020-10-02 |
| 1790382760 | Christopher Tran | Nurse Practitioner | 11441 Heacock St Ste F, Moreno Valley, CA 92557-7907 | 2020-10-02 |
| 1487266292 | Mollie Shira Hudson | Nurse Practitioner | 14 Whitmore Pl Apt 15, Oakland, CA 94611-4635 | 2020-08-21 |
| 1962014381 | Mario Javier Herrera | Nurse Practitioner | 2130 High Pointe Dr, Apt 108, Corona, CA 92879 | 2020-08-18 |
| 1952912131 | Norman Ivan Kier | Nurse Practitioner | 3834 Edison Ave, Sacramento, CA 95821-2728 | 2020-08-12 |
| 1942811377 | Thanhan Mathews | Nurse Practitioner | 114 W Cameron St Apt B, Hanford, CA 93230-2965 | 2020-08-10 |
| 1972113355 | Marine Mary Kademyan | Nurse Practitioner | 6528 Babcock Ave, North Hollywood, CA 91606 | 2020-07-31 |
| 1245849645 | Shannon Pereira | Nurse Practitioner | 2368 Honeysuckle Way, Hemet, CA 92545-4796 | 2020-07-31 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.