Healthcare Provider Details

I. General information

NPI: 1396281713
Provider Name (Legal Business Name): SAN MIGUEL URGENT CARE ANAHEIM A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2017
Last Update Date: 04/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 S BROOKHURST ST STE A
ANAHEIM CA
92804-4321
US

IV. Provider business mailing address

710 S BROOKHURST ST STE A
ANAHEIM CA
92804-4321
US

V. Phone/Fax

Practice location:
  • Phone: 714-494-1331
  • Fax: 714-494-1332
Mailing address:
  • Phone: 714-494-1331
  • Fax: 714-494-1332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License NumberA34248
License Number StateCA

VIII. Authorized Official

Name: DR. MAHFOUZ MICHAEL
Title or Position: PRESIDENT
Credential: M.D.
Phone: 714-494-1331