Organization
UPTIMUM MEDICAL GROUP AND IPA INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
OLUKEMI A WALLACE MD (DIRECTOR)
(310) 644-8400
Entity
Organization
Contact information
Practice address
2220 W MANCHESTER BLVD, INGLEWOOD, CA 90305-2514
(310) 644-8400
(310) 644-8424
Mailing address
2220 W MANCHESTER BLVD, INGLEWOOD, CA 90305-2514
(310) 644-8400
(310) 644-8424
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8831128
—
CA
Enumeration date
10/02/2024
Last updated
10/02/2024
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