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General NPI Number Information
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NPI Number | 1124754627
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Entity Type | Organization
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Legal Business Name | INTEGRATED MEDICAL CENTER DTLA PC
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Dates
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Enumeration Date | 07/27/2022
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Last Update Date | 08/25/2022
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Provider Practice Location Address
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Address Line | 1055 WILSHIRE BLVD STE 1930
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City | LOS ANGELES
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State | CA
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Zip | 90017-5602
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Country | US
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Telephone | 310-259-7748
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Fax |
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Provider Business Mailing Address
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Address Line | 1055 WILSHIRE BLVD STE 1930
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City | LOS ANGELES
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State | CA
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Zip | 90017-5602
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | PAULO VILLANUEVA
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Credential |
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Telephone | 310-259-7748
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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