Provider Demographics
NPI:1487875191
Name:CAREONE MEDICAL GROUP, INC.
Entity type:Organization
Organization Name:CAREONE MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-965-1988
Mailing Address - Street 1:2705 S DIAMOND BAR BLVD STE 128
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-3557
Mailing Address - Country:US
Mailing Address - Phone:626-965-1988
Mailing Address - Fax:626-236-9394
Practice Address - Street 1:2705 S DIAMOND BAR BLVD STE 128
Practice Address - Street 2:
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-3557
Practice Address - Country:US
Practice Address - Phone:626-965-1988
Practice Address - Fax:626-236-9394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty