Healthcare Provider Details

I. General information

NPI: 1609017805
Provider Name (Legal Business Name): INTEGRATIVE MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2009
Last Update Date: 03/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

526 W 17TH ST
SANTA ANA CA
92706-3619
US

IV. Provider business mailing address

526 W 17TH ST
SANTA ANA CA
92706-3619
US

V. Phone/Fax

Practice location:
  • Phone: 714-558-9355
  • Fax: 714-558-0870
Mailing address:
  • Phone: 714-558-9355
  • Fax: 714-558-0870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA53229
License Number StateCA

VIII. Authorized Official

Name: MS. PATRICIA HALE
Title or Position: ADMINISTRATOR
Credential:
Phone: 714-558-9355