Healthcare Provider Details

I. General information

NPI: 1982271573
Provider Name (Legal Business Name): USC CARE MEDICAL GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2021
Last Update Date: 06/10/2021
Certification Date: 06/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 EASTLAKE AVE STE 5409
LOS ANGELES CA
90089-1020
US

IV. Provider business mailing address

PO BOX 31309
LOS ANGELES CA
90031-0309
US

V. Phone/Fax

Practice location:
  • Phone: 323-865-0563
  • Fax: 323-865-0122
Mailing address:
  • Phone: 323-865-0563
  • Fax: 323-865-0122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: NARSING A RAO
Title or Position: VICE CHAIR
Credential: MD
Phone: 323-442-5551