Organization
UPTIMUM CARE MEDICAL GROUP &IPA INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. OLUKEMI A WALLACE MD (DIRECTOR)
(310) 644-8400
Entity
Organization
Contact information
Practice address
15342 HAWTHORNE BLVD, STE 102, LAWNDALE, CA 90260-2152
(310) 644-8400
Mailing address
2220 W MANCHESTER BLVD, INGLEWOOD, CA 90305-2514
(310) 644-8400
(310) 644-8424
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
A48240
CA
282N00000X
General Acute Care Hospital
23055
CA
302R00000X
Health Maintenance Organization
23055
CA
305R00000X
Preferred Provider Organization
Primary
23055
CA
305S00000X
Point of Service
23055
CA
3104A0630X
Assisted Living Facility (Behavioral Disturbances)
23055
CA
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
23055
CA
Other
Enumeration date
07/24/2013
Last updated
07/21/2022
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