# INTEGRATED MEDICAL GROUP INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1871931741
- **Authorized official:** MR. CHARLES SIMBULAN (CEO)
- **Authorized official phone:** (818) 224-9390

## Contact information

- **Practice address:** 208 E CARSON ST STE 101, CARSON, CA 90745-2762
- **Practice address phone:** (818) 224-9390
- **Practice address fax:** (818) 938-1538
- **Mailing address:** 8622 RESEDA BLVD STE 200, NORTHRIDGE, CA 91324-4091
- **Mailing address phone:** (818) 224-9390
- **Mailing address fax:** (818) 938-1538

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP2300X | Primary Care Nurse Practitioner | C3565047 | CA | Yes |

## Other

- **Enumeration date:** 06/12/2013
- **Last updated:** 06/19/2016