Healthcare Provider Details
I. General information
NPI: 1073240529
Provider Name (Legal Business Name): INFUCARE MEDICAL GROUP OF CALIFORNIA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 08/04/2022
Last Update Date: 09/03/2025
Certification Date: 09/03/2025
Deactivation Date:
Reactivation Date:
III. Provider practice location address
7625 MESA COLLEGE DR STE 250A
SAN DIEGO CA
92111-5343
US
IV. Provider business mailing address
16782 VON KARMAN AVE STE 12
IRVINE CA
92606-2417
US
V. Phone/Fax
- Phone: 844-243-7833
- Fax:
- Phone: 858-314-9222
- Fax: 949-864-2320
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 208D00000X |
| Taxonomy | General Practice Physician |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 251F00000X |
| Taxonomy | Home Infusion Agency |
| License Number | |
| License Number State | |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 261QI0500X |
| Taxonomy | Infusion Therapy Clinic/Center |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
GENEVIEVE
BENJAMIN
Title or Position: CEO
Credential: R.PH.
Phone: 949-783-7009