Healthcare Provider Details

I. General information

NPI: 1487875191
Provider Name (Legal Business Name): CAREONE MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2705 S DIAMOND BAR BLVD STE 128
DIAMOND BAR CA
91765-3557
US

IV. Provider business mailing address

2705 S DIAMOND BAR BLVD STE 128
DIAMOND BAR CA
91765-3557
US

V. Phone/Fax

Practice location:
  • Phone: 626-965-1988
  • Fax: 626-236-9394
Mailing address:
  • Phone: 626-965-1988
  • Fax: 626-236-9394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. ALICE LEE
Title or Position: ADMINISTRATOR
Credential:
Phone: 626-965-1988