Basic Information
| Provider Information | |||||||||
| NPI: | 1629143821 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | IMMEDIATE FAMILY MEDICAL CARE NORTH | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 50042 | ||||||||
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| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900740042 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6616782300 | ||||||||
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| Practice Location | |||||||||
| Address1: | 25285 MADISON AVENUE | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | MURRIETA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925628293 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9516009070 | ||||||||
| FaxNumber: | 9516009177 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/22/2006 | ||||||||
| LastUpdateDate: | 10/07/2008 | ||||||||
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| AuthorizedOfficialLastName: | OKUN | ||||||||
| AuthorizedOfficialFirstName: | LEONARD | ||||||||
| AuthorizedOfficialMiddleName: | M. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8585651300 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | U.S. HEALTHWORKS MEDICAL GROUP, PC | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2083P0500X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Preventive Medicine | Preventive Medicine/Occupational Environmental Medicine | 2083X0100X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Preventive Medicine | Occupational Medicine |
No ID Information.