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Organization
INJURED WORKERS MEDICAL GROUP, INC.
Active
Organization
INJURED WORKERS MEDICAL GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VRIJESH SHANTANU TANTUWAYA MD (PRESIDENT)
(858) 472-1380
Entity
Organization
Contact information
Practice address
4600 CAMPUS DR STE 108, NEWPORT BEACH, CA 92660-1885
(949) 769-6071
Mailing address
14252 CULVER DR STE 295, IRVINE, CA 92604-0317
Taxonomy
Speciality
Code
Description
License number
State
111NX0100X
Occupational Health Chiropractor
—
NULL
111NX0100X
Occupational Health Chiropractor
—
—
207X00000X
Orthopaedic Surgery Physician
Primary
—
NULL
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
261QX0100X
Occupational Medicine Clinic/Center
—
NULL
Other
Enumeration date
08/22/2020
Last updated
08/22/2020
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