NPIMap

Organization Active NPI

Renew Integrated Program-2 Inc.

  • Community/Behavioral Health Agency
  • La Puente, CA
National Provider Identifier
1083974364
Registry record updated May 24, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
A66124 Issued in CA
Legal business name
RENEW INTEGRATED PROGRAM-2 INC.
Practice address
751 Vineland Ave
La Puente, CA 91746-1914
Phone
(562) 426-3300
Fax
(562) 637-3244
NPI assigned
May 21, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 24, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Laja I. Ibraheem, MD
Title
Owner
Phone
(562) 426-3300

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X A66124 CA Primary

Addresses

Primary practice location

751 Vineland Ave
La Puente, CA 91746-1914

Mailing address

4000 Long Beach Blvd
228
Long Beach, CA 90807-2617
Phone (562) 426-3300

Other identifiers 1

IdentifierTypeStateIssuer
7205OtherCADRUG MEDI-CAL

National Provider Directory

National Provider Directory
Tax ID family
Renew Integrated Program-2 Inc26 organizations share this tax ID, including this one

Other organizations with this tax ID 25

Organizations that report the same tax identification number in the National Provider Directory.

View all 25

Locations

751 Vineland Ave
City of Industry, CA 91746
Phone (310) 670-6767

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1337558400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1337817600000",
    "number": "1083974364",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4000 LONG BEACH BLVD",
            "address_2": "228",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908072617",
            "telephone_number": "562-426-3300",
            "fax_number": "562-637-3244"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "751 VINELAND AVE",
            "city": "LA PUENTE",
            "state": "CA",
            "postal_code": "917461914",
            "telephone_number": "562-426-3300",
            "fax_number": "562-637-3244"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENEW INTEGRATED PROGRAM-2 INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-21",
        "last_updated": "2012-05-24",
        "status": "A",
        "authorized_official_last_name": "IBRAHEEM",
        "authorized_official_first_name": "LAJA",
        "authorized_official_middle_name": "I.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "562-426-3300",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "CA",
            "license": "A66124",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DRUG MEDI-CAL",
            "identifier": "7205",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in La Puente, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.