Healthcare Provider Details

I. General information

NPI: 1316635097
Provider Name (Legal Business Name): RELIANT IMMEDIATE CARE MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2023
Last Update Date: 05/01/2023
Certification Date: 04/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 W CENTURY BLVD
LOS ANGELES CA
90045-5411
US

IV. Provider business mailing address

PO BOX 80243
CITY OF INDUSTRY CA
91716-8243
US

V. Phone/Fax

Practice location:
  • Phone: 310-215-6020
  • Fax: 310-491-7068
Mailing address:
  • Phone: 310-215-6020
  • Fax: 424-888-7648

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MAX FRANKLIN LEBOW
Title or Position: PRESIDENT
Credential: MD
Phone: 310-215-6020