Healthcare Provider Details

I. General information

NPI: 1962663393
Provider Name (Legal Business Name): TOWN CENTER PLAZA URGENT CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2008
Last Update Date: 06/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19015 TOWN CENTER DRIVE SUITE 102
APPLE VALLEY CA
92308
US

IV. Provider business mailing address

19015 TOWN CENTER DR SUITE 102
APPLE VALLEY CA
92308
US

V. Phone/Fax

Practice location:
  • Phone: 760-247-4175
  • Fax: 760-247-3986
Mailing address:
  • Phone: 760-247-4175
  • Fax: 760-247-3986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License NumberA46329
License Number StateCA

VIII. Authorized Official

Name: MS. NANCY A GLASS
Title or Position: OFFICE MANAGER
Credential: MA
Phone: 760-247-0581