Healthcare Provider Details

I. General information

NPI: 1801154463
Provider Name (Legal Business Name): TOTAL CARE MEDICAL CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2012
Last Update Date: 05/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 W ANAHEIM ST SUITE 6
WILMINGTON CA
90744-4131
US

IV. Provider business mailing address

1110 W ANAHEIM ST SUITE 6
WILMINGTON CA
90744-4131
US

V. Phone/Fax

Practice location:
  • Phone: 310-872-3560
  • Fax: 310-221-8645
Mailing address:
  • Phone: 310-872-3560
  • Fax: 310-221-8645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. NKWAIN W NGAMFON
Title or Position: ADMINISTRATOR
Credential: PA
Phone: 424-215-1580