MEDICARE: INTEGRATED HEALTHCARE MEDICAL GROUP 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
1	207Q00000X	Family Medicine Physician	A38857	CA

Other Identifiers

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

General Provider Information

NPI Number	:	1801805056
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTEGRATED HEALTHCARE MEDICAL GROUP INC.

Provider Business Mailing Address
First Line	:	1762 WESTWOOD BLVD STE 300
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90024-5641
Country	:	US
Telephone Number	:	310-441-2000
Fax Number	:	310-441-2020

Provider Business Practice Location Address
First Line	:	1762 WESTWOOD BLVD STE 300
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90024-5641
Country	:	US
Telephone Number	:	310-441-2000
Fax Number	:	310-441-2020

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. IFRAIN CONTRERAS
Credential	:
Telephone Number	:	310-419-4303

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	08/06/2024

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