1346607603 NPI number — UNIFIED CARE MEDICAL GROUP, INC.

Table of content: WAI COUR OR (NPI 1487839692)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346607603 NPI number — UNIFIED CARE MEDICAL GROUP, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIFIED CARE MEDICAL GROUP, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
UNIFIED CARE MEDICAL GROUP
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346607603
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/09/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2040 PACIFIC COAST HWY
Provider Second Line Business Mailing Address:
SUITE S
Provider Business Mailing Address City Name:
LOMITA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90717-2660
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
424-347-8008
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2040 PACIFIC COAST HWY
Provider Second Line Business Practice Location Address:
SUITE S
Provider Business Practice Location Address City Name:
LOMITA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90717-2660
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
424-347-8008
Provider Business Practice Location Address Fax Number:
844-481-9664
Provider Enumeration Date:
01/18/2016

Additional Information

Authorized Official

Authorized Official Last Name:
RAMOS
Authorized Official First Name:
RODERICK
Authorized Official Middle Name:
P
Authorized Official Title or Position:
COO
Authorized Official Telephone Number:
424-347-8008

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: A25005 . This is a "MANUEL BACULI MD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: PA19706 . This is a "RODERICK P RAMOS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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