Healthcare Provider Details

I. General information

NPI: 1750656799
Provider Name (Legal Business Name): INTEGRATED PHYSICIANS MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2012
Last Update Date: 11/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 S BARRINGTON AVE SUITE 101
LOS ANGELES CA
90025-5363
US

IV. Provider business mailing address

2001 S BARRINGTON AVE SUITE 101
LOS ANGELES CA
90025-5363
US

V. Phone/Fax

Practice location:
  • Phone: 310-575-5575
  • Fax: 310-575-5570
Mailing address:
  • Phone: 310-575-5575
  • Fax: 310-575-5570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC19493
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberC54648
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number StateCA

VIII. Authorized Official

Name: DR. JEFFREY JAMES
Title or Position: PRESIDENT
Credential:
Phone: 310-575-5575