MEDICARE: JULIUS IRUMUNDOMON

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	302R00000X	Health Maintenance Organization	55000737	CA

General Provider Information

NPI Number	:	1851602189
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JULIUS IRUMUNDOMON

Provider Business Mailing Address
First Line	:	235 E BROADWAY STE 424
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90802-7815
Country	:	US
Telephone Number	:	562-285-0432
Fax Number	:	562-285-0521

Provider Business Practice Location Address
First Line	:	235 E BROADWAY STE 424
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90802-7815
Country	:	US
Telephone Number	:	562-285-0432
Fax Number	:	562-285-0521

Authorized Official
Title or Position	:	ADMINISTRATOR / CEO
Name	:	MR. JULIUS IRUMUNDOMON
Credential	:	RCP
Telephone Number	:	562-285-0432

Provider Enumeration Date	:	07/01/2010
Last Update Date	:	07/01/2010

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