MEDICARE: RELIANT IMMEDIATE CARE 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	207P00000X	Emergency Medicine Physician		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

General Provider Information

NPI Number	:	1801838198
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RELIANT IMMEDIATE CARE MEDICAL GROUP, INC.

Provider Business Mailing Address
First Line	:	9601 S SEPULVEDA BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-5203
Country	:	US
Telephone Number	:	310-215-6020
Fax Number	:	310-641-3521

Provider Business Practice Location Address
First Line	:	9601 S SEPULVEDA BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-5203
Country	:	US
Telephone Number	:	310-215-6020
Fax Number	:	310-641-3521

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MAX F LEBOW
Credential	:	M.D.
Telephone Number	:	310-215-6020

Provider Enumeration Date	:	06/12/2006
Last Update Date	:	07/21/2022

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