| CASE NUMBER | I-200-25015-621126 |
| CASE STATUS | Certified |
| RECEIVED DATE | 1/15/2025 |
| DECISION DATE | 1/23/2025 |
| ORIGINAL CERT DATE | |
| VISA CLASS | H-1B |
| JOB TITLE | Nurse Practitioner |
| SOC CODE | 29-1171.00 |
| SOC TITLE | Nurse Practitioners |
| FULL TIME POSITION | Y |
| BEGIN DATE | 2/1/2025 |
| END DATE | 1/31/2028 |
| TOTAL WORKER POSITIONS | 1 |
| NEW EMPLOYMENT | 0 |
| CONTINUED EMPLOYMENT | 0 |
| CHANGE PREVIOUS EMPLOYMENT | 0 |
| NEW CONCURRENT EMPLOYMENT | 0 |
| CHANGE EMPLOYER | 1 |
| AMENDED PETITION | 0 |
| EMPLOYER NAME | Intercommunity Health Associates |
| TRADE NAME DBA | PIH Health Physicians Medical Group |
| EMPLOYER ADDRESS1 | 6557 Greenleaf Ave. |
| EMPLOYER ADDRESS2 | |
| EMPLOYER CITY | Whittier |
| EMPLOYER STATE | CA |
| EMPLOYER POSTAL CODE | 90601 |
| EMPLOYER COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER PROVINCE | |
| EMPLOYER PHONE | 15627895401 |
| EMPLOYER PHONE EXT | |
| NAICS CODE | 813910 |
| EMPLOYER POC LAST NAME | Miyamoto |
| EMPLOYER POC FIRST NAME | Keith |
| EMPLOYER POC MIDDLE NAME | |
| EMPLOYER POC JOB TITLE | Chairman, Board of Directors |
| EMPLOYER POC ADDRESS1 | 6557 Greenleaf Ave. |
| EMPLOYER POC ADDRESS2 | |
| EMPLOYER POC CITY | Whittier |
| EMPLOYER POC STATE | CA |
| EMPLOYER POC POSTAL CODE | 90601 |
| EMPLOYER POC COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER POC PROVINCE | |
| EMPLOYER POC PHONE | 15627895401 |
| EMPLOYER POC PHONE EXT | 8229 |
| EMPLOYER POC EMAIL | keith.miyamoto@pihhealth.org |
| AGENT REPRESENTING EMPLOYER | Yes |
| AGENT ATTORNEY LAST NAME | Juarez Contreras |
| AGENT ATTORNEY FIRST NAME | Jioselin |
| AGENT ATTORNEY MIDDLE NAME | Azusena |
| AGENT ATTORNEY ADDRESS1 | 15925 Carmenita Rd. |
| AGENT ATTORNEY ADDRESS2 | |
| AGENT ATTORNEY CITY | Cerritos |
| AGENT ATTORNEY STATE | CA |
| AGENT ATTORNEY POSTAL CODE | 90703 |
| AGENT ATTORNEY COUNTRY | UNITED STATES OF AMERICA |
| AGENT ATTORNEY PROVINCE | |
| AGENT ATTORNEY PHONE | 15624830450 |
| AGENT ATTORNEY PHONE EXT | |
| AGENT ATTORNEY EMAIL ADDRESS | renju.jose@chugh.com |
| LAWFIRM NAME BUSINESS NAME | Chugh, LLP |
| STATE OF HIGHEST COURT | CA |
| NAME OF HIGHEST STATE COURT | Supreme Court |
| WORKSITE WORKERS | 1 |
| SECONDARY ENTITY | No |
| SECONDARY ENTITY BUSINESS NAME | |
| WORKSITE ADDRESS1 | 16510 Bloomfield Ave. |
| WORKSITE ADDRESS2 | |
| WORKSITE CITY | Cerritos |
| WORKSITE COUNTY | LOS ANGELES |
| WORKSITE STATE | CA |
| WORKSITE POSTAL CODE | 90703 |
| WAGE RATE OF PAY FROM | $150,000.00 |
| WAGE RATE OF PAY FROM CLEANED | |
| WAGE RATE OF PAY TO | |
| WAGE UNIT OF PAY | Year |
| PREVAILING WAGE | $136,739.00 |
| PW UNIT OF PAY | Year |
| PW TRACKING NUMBER | |
| PW WAGE LEVEL | II |
| PW OES YEAR | 7/1/2024 - 6/30/2025 |
| PW OTHER SOURCE | |
| PW OTHER YEAR | |
| PW SURVEY PUBLISHER | |
| PW SURVEY NAME | |
| TOTAL WORKSITE LOCATIONS | 1 |
| AGREE TO LC STATEMENT | Yes |
| H 1B DEPENDENT | No |
| WILLFUL VIOLATOR | No |
| SUPPORT H1B | N/A |
| STATUTORY BASIS | |
| APPENDIX A ATTACHED | N/A |
| PUBLIC DISCLOSURE | Disclose Business |
| PREPARER LAST NAME | Jose |
| PREPARER FIRST NAME | Renju |
| PREPARER MIDDLE INITIAL | |
| PREPARER BUSINESS NAME | CHUGH, LLP |
| PREPARER EMAIL | renju.jose@chugh.com |
| BEGIN DATE CONVERTED | 2025-02-01 |
