Healthcare Provider Details

I. General information

NPI: 1891075016
Provider Name (Legal Business Name): EXPRESS LANE URGENT CARE FREMONT, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2011
Last Update Date: 08/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1999 MOWRY AVE SUITE L
FREMONT CA
94538-1738
US

IV. Provider business mailing address

1999 MOWRY AVE SUITE L
FREMONT CA
94538-1738
US

V. Phone/Fax

Practice location:
  • Phone: 510-791-6220
  • Fax: 510-791-2378
Mailing address:
  • Phone: 510-791-6220
  • Fax: 510-791-2378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: PAUL ROGER ANDERSON
Title or Position: PHYSICIAN ASSISTANT
Credential:
Phone: 209-535-7500