Healthcare Provider Details

I. General information

NPI: 1215030747
Provider Name (Legal Business Name): INTEGRATIVE MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 09/11/2025
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

1930 WILSHIRE BLVD STE 1100
LOS ANGELES CA
90057-3605
US

V. Phone/Fax

Practice location:
  • Phone: 714-558-9355
  • Fax: 714-558-0870
Mailing address:
  • Phone: 213-483-2620
  • Fax: 213-483-7918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA14480
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA14957
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA31911
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA49332
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberA26210
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA38978
License Number StateCA

VIII. Authorized Official

Name: DR. WALTER JAYASINGHE
Title or Position: OWNER
Credential: M.D.
Phone: 213-483-2620