| First Integrated Care Medical Group Inc | |
|
1339 W Willow St Long Beach CA 90810-3116 | |
| (562) 492-6698 | |
| (562) 492-9553 |
| Full Name | First Integrated Care Medical Group Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 1339 W Willow St, Long Beach, California |
| Authorized Official Name and Position | Elnora T Tabila (OFFICE MANAGER) |
| Authorized Official Contact | 5624926698 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| First Integrated Care Medical Group Inc 1339 W Willow St Long Beach CA 90810-3116 Ph: (562) 492-6698 | First Integrated Care Medical Group Inc 1339 W Willow St Long Beach CA 90810-3116 Ph: (562) 492-6698 |
| NPI Number | 1720077852 |
|---|---|
| Provider Enumeration Date | 10/20/2005 |
| Last Update Date | 03/05/2021 |
| Certification Date | 03/05/2021 |
| Medicare PECOS PAC ID | 3971541459 |
|---|---|
| Medicare Enrollment ID | O20050425000712 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720077852 | NPI | - | NPPES |
| 00A385440 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | A38544 (California) | Primary |
| Provider Name | Rodolfo T Tabila |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1962538181 PECOS PAC ID: 1759549298 Enrollment ID: I20120229000809 |
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