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General NPI Number Information
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NPI Number | 1083042840
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Entity Type | Organization
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Legal Business Name | INDUSTRIAL MEDICAL CARE INC
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Dates
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Enumeration Date | 10/14/2013
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Last Update Date | 10/14/2013
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Provider Practice Location Address
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Address Line | 12401 SLAUSON AVE STE A
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City | WHITTIER
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State | CA
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Zip | 90606-2830
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Country | US
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Telephone | 657-235-8112
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Fax |
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Provider Business Mailing Address
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Address Line | 3123 BERMUDA DR
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City | COSTA MESA
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State | CA
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Zip | 92626-2303
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Country | US
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Telephone | 657-235-8112
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | VLADIMIRE KAYE
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Credential | MD
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Telephone | 657-235-8112
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A64244
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License Number State | CA
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