Provider Demographics
NPI:1316635097
Name:RELIANT IMMEDIATE CARE MEDICAL GROUP, INC.
Entity type:Organization
Organization Name:RELIANT IMMEDIATE CARE MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAX
Authorized Official - Middle Name:FRANKLIN
Authorized Official - Last Name:LEBOW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-215-6020
Mailing Address - Street 1:PO BOX 80243
Mailing Address - Street 2:
Mailing Address - City:CITY OF INDUSTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91716-8243
Mailing Address - Country:US
Mailing Address - Phone:310-215-6020
Mailing Address - Fax:424-888-7648
Practice Address - Street 1:5901 W CENTURY BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-5411
Practice Address - Country:US
Practice Address - Phone:310-215-6020
Practice Address - Fax:310-491-7068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty