Integrated Medical Group Inc

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

License

C3565047 Issued in CA

Legal business name

INTEGRATED MEDICAL GROUP INC

Practice address

208 E Carson St Ste 101
Carson, CA 90745-2762

Phone

(818) 224-9390

Fax

(818) 938-1538

NPI assigned

Jun 12, 2013

Last updated

Jun 19, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Charles Simbulan

Title

Ceo

Phone

(818) 224-9390

Specialties & licenses 1

Addresses

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Poncia Reed, APRN

  • Adult Health Nurse Practitioner
  • Las Vegas, NV
  • NPI 1821498213
  NPD (past)
• Marguarette Jean Suprien

  • Family Nurse Practitioner
  • N Las Vegas, NV
  • NPI 1881051415
  NPD (past)
• Anuradha Thirumalai, FNP-BC

  • Family Nurse Practitioner
  • Las Vegas, NV
  • NPI 1306217534
  NPD (past)

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

{
    "created_epoch": "1370995200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1466294400000",
    "number": "1871931741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8622 RESEDA BLVD STE 200",
            "city": "NORTHRIDGE",
            "state": "CA",
            "postal_code": "913244091",
            "telephone_number": "818-224-9390",
            "fax_number": "818-938-1538"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "208 E CARSON ST STE 101",
            "city": "CARSON",
            "state": "CA",
            "postal_code": "907452762",
            "telephone_number": "818-224-9390",
            "fax_number": "818-938-1538"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRATED MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-12",
        "last_updated": "2016-06-19",
        "status": "A",
        "authorized_official_last_name": "SIMBULAN",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "818-224-9390",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "CA",
            "license": "C3565047",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Queen A Igbonagwam, PMHNP
• Irene Igual, N.P.
• Image N You Ultrasound Studio LLC
• Independent Physical Therapy Inc
• Marlo Loyola Ines
• Shigeo Irimajiri, M.D.
• Lorraine Ito, PTA
• Ukpong Ekanem Ito
• J&T Home Care
• Brandi Jackson

• Primary Care Nurse Practitioner in Carson, CA
• Providers in Carson, CA by specialty
• Primary Care Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2016; 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.