Healthcare Provider Details

I. General information

NPI: 1275784324
Provider Name (Legal Business Name): FAMILY URGENT CARE & INDUSTRIAL MEDICAL CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2008
Last Update Date: 11/14/2025
Certification Date: 11/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16542 VENTURA BLVD STE 500
ENCINO CA
91436-4510
US

IV. Provider business mailing address

16542 VENTURA BLVD STE 500
ENCINO CA
91436-4510
US

V. Phone/Fax

Practice location:
  • Phone: 818-808-2828
  • Fax: 818-788-0386
Mailing address:
  • Phone: 818-808-2828
  • Fax: 818-788-0386

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberFNP24261
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: BRUCE E FISHMAN
Title or Position: PRESIDENT/MEDICAL DIRECTOR
Credential: M.D.
Phone: 818-808-2828