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NPI Code Detail

MEDICARE: UPTIMUM MEDICAL GROUP AND IPA INC

MEDICARE: UPTIMUM MEDICAL GROUP AND IPA INC
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
1174400000XSpecialistA48240CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1568649226
Entity Type Code : Organization
Provider Name (Legal Business Name) : UPTIMUM MEDICAL GROUP AND IPA INC
Provider Business Mailing Address
First Line : 15342 HAWTHORNE BLVD STE 102
Second Line :
City : LAWNDALE
State : CA
Zip : 90260-2181
Country : US
Telephone Number : 310-644-8400
Fax Number : 310-644-8424
Provider Business Practice Location Address
First Line : 2220 W MANCHESTER BLVD
Second Line :
City : INGLEWOOD
State : CA
Zip : 90305-2514
Country : US
Telephone Number : 310-644-8400
Fax Number :
Authorized Official
Title or Position : DIRECTOR
Name : DR. OLUKEMI ADERONKE WALLACE
Credential : M.D.
Telephone Number : 310-644-8400
Provider Enumeration Date : 01/24/2008
Last Update Date : 10/08/2024

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Directions to “UPTIMUM MEDICAL GROUP AND IPA INC ” Practice Location

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