MEDICARE: INTEGRITY AND CARE PEDIATRICS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center	A115544	CA

General Provider Information

NPI Number	:	1285043257
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTEGRITY AND CARE PEDIATRICS

Provider Business Mailing Address
First Line	:	2357 DELTA AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90810-3330
Country	:	US
Telephone Number	:	703-380-9434
Fax Number	:

Provider Business Practice Location Address
First Line	:	12665 GARDEN GROVE BLVD STE 713
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92843-1921
Country	:	US
Telephone Number	:	714-537-6595
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	HENRY NGUYEN
Credential	:
Telephone Number	:	703-380-9434

Provider Enumeration Date	:	08/04/2014
Last Update Date	:	08/04/2014

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