Provider Demographics
NPI:1700361029
Name:UNIMED HEALTH CENTER GROUP INC
Entity type:Organization
Organization Name:UNIMED HEALTH CENTER GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:AMBROSE
Authorized Official - Middle Name:
Authorized Official - Last Name:FUERTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-968-1170
Mailing Address - Street 1:4065 WHITTIER BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90023-2556
Mailing Address - Country:US
Mailing Address - Phone:323-968-1170
Mailing Address - Fax:323-968-1175
Practice Address - Street 1:4065 WHITTIER BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90023-2556
Practice Address - Country:US
Practice Address - Phone:323-968-1170
Practice Address - Fax:323-968-1175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-02
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty