Organization
INTEGRATIVE MEDICAL GROUP, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RYAN M SPIVAK M.D (AUTHORIZED OFFICIAL)
(310) 905-3331
Entity
Organization
Contact information
Practice address
2200 W 3RD ST, SUITE 120 A, LOS ANGELES, CA 90057-1932
(310) 905-3331
(310) 453-2916
Mailing address
2200 W 3RD ST, SUITE 120 A, LOS ANGELES, CA 90057-1932
(310) 905-3331
(310) 453-2916
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
A113632
CA
Other
Enumeration date
08/03/2016
Last updated
08/03/2016
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