Provider Demographics
NPI:1801154463
Name:TOTAL CARE MEDICAL CLINIC INC
Entity type:Organization
Organization Name:TOTAL CARE MEDICAL CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:NKWAIN
Authorized Official - Middle Name:W
Authorized Official - Last Name:NGAMFON
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:424-215-1580
Mailing Address - Street 1:1110 W ANAHEIM ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:WILMINGTON
Mailing Address - State:CA
Mailing Address - Zip Code:90744-4131
Mailing Address - Country:US
Mailing Address - Phone:310-872-3560
Mailing Address - Fax:310-221-8645
Practice Address - Street 1:1110 W ANAHEIM ST
Practice Address - Street 2:SUITE 6
Practice Address - City:WILMINGTON
Practice Address - State:CA
Practice Address - Zip Code:90744-4131
Practice Address - Country:US
Practice Address - Phone:310-872-3560
Practice Address - Fax:310-221-8645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-01
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health