Provider Demographics
NPI:1548856586
Name:ONE MISSION MEDICAL INC
Entity type:Organization
Organization Name:ONE MISSION MEDICAL INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:MANUEL
Authorized Official - Last Name:ORIGEL
Authorized Official - Suffix:JR
Authorized Official - Credentials:MSN, FNP
Authorized Official - Phone:818-610-6536
Mailing Address - Street 1:10200 SEPULVEDA BLVD STE 140
Mailing Address - Street 2:
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91345-3323
Mailing Address - Country:US
Mailing Address - Phone:818-610-6536
Mailing Address - Fax:818-450-0133
Practice Address - Street 1:10200 SEPULVEDA BLVD STE 140
Practice Address - Street 2:
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-3323
Practice Address - Country:US
Practice Address - Phone:818-610-6536
Practice Address - Fax:818-450-0133
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ONE MISSION MEDICAL INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-12-14
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty