Healthcare Provider Details

I. General information

NPI: 1205041290
Provider Name (Legal Business Name): SOUTHERN CALIFORNIA IMMEDIATE MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15330 VALLEY VIEW AVE STE 1
LA MIRADA CA
90638-5238
US

IV. Provider business mailing address

7300 ALONDRA BLVD STE 101
PARAMOUNT CA
90723-4000
US

V. Phone/Fax

Practice location:
  • Phone: 562-802-0208
  • Fax: 562-802-0999
Mailing address:
  • Phone: 562-531-8300
  • Fax: 562-531-8035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number20 A5386
License Number StateCA

VIII. Authorized Official

Name: THONAS ROCCAPALUMBO
Title or Position: MEDICAL DIRECTOR
Credential: DO
Phone: 323-726-3212