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General NPI Number Information
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NPI Number | 1942607080
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Entity Type | Organization
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Legal Business Name | INTERNATIONAL MEDICAL TECHNOLOGY, INC
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Dates
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Enumeration Date | 12/03/2014
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 31717 TEMECULA PKWY
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City | TEMECULA
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State | CA
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Zip | 92592-5869
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Country | US
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Telephone | 951-302-1888
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Fax | 951-302-9888
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Provider Business Mailing Address
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Address Line | 31717 TEMECULA PKWY
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City | TEMECULA
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State | CA
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Zip | 92592-5869
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Country | US
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Telephone | 951-302-1888
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Fax | 951-302-9888
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | MR. FOUAD A SALAMA
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Credential | M.D
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Telephone | 951-302-1888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | C50309
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License Number State | CA
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