Healthcare Provider Details

I. General information

NPI: 1902178122
Provider Name (Legal Business Name): INTENSIVE CARE MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2012
Last Update Date: 03/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18300 ROSCOE BLVD
NORTHRIDGE CA
91325-4105
US

IV. Provider business mailing address

PO BOX 11307
SAN BERNARDINO CA
92423-1307
US

V. Phone/Fax

Practice location:
  • Phone: 818-885-5440
  • Fax: 818-885-5497
Mailing address:
  • Phone: 818-885-5440
  • Fax: 818-885-5497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: NARIMAN SADDAD
Title or Position: PRESIDENT/CEO
Credential: M.D.
Phone: 818-885-5440