Healthcare Provider Details

I. General information

NPI: 1467963751
Provider Name (Legal Business Name): INTEGRATED INJURY SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2017
Last Update Date: 10/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1041 E YORBA LINDA BLVD STE 210
PLACENTIA CA
92870-3763
US

IV. Provider business mailing address

PO BOX 61326
IRVINE CA
92602-6044
US

V. Phone/Fax

Practice location:
  • Phone: 949-424-3763
  • Fax: 951-461-7074
Mailing address:
  • Phone: 949-424-5840
  • Fax: 951-461-7074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: DENISE BALKCOM
Title or Position: ADMINISTRATOR
Credential:
Phone: 888-268-8607