Healthcare Provider Details

I. General information

NPI: 1043359433
Provider Name (Legal Business Name): PROCARE WORK INJURY CENTER & URGENT CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18582 BEACH BLVD STE 23A
HUNTINGTON BEACH CA
92648-2012
US

IV. Provider business mailing address

17232 RED HILL AVE
IRVINE CA
92614-5628
US

V. Phone/Fax

Practice location:
  • Phone: 714-964-4442
  • Fax: 714-963-3780
Mailing address:
  • Phone: 949-752-1111
  • Fax: 949-752-1133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA74672
License Number StateCA

VIII. Authorized Official

Name: MS. SOLONGO GOMBOSUREN
Title or Position: OFFICE MANAGER
Credential: BA, MBA
Phone: 949-752-1111