Healthcare Provider Details

I. General information

NPI: 1477707701
Provider Name (Legal Business Name): LATHROP URGENT CARE, A PROFESSIONAL MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2008
Last Update Date: 12/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15810 S HARLAN RD STE A
LATHROP CA
95330-8719
US

IV. Provider business mailing address

PO BOX 829
WOODBRIDGE CA
95258-0829
US

V. Phone/Fax

Practice location:
  • Phone: 209-983-9000
  • Fax: 209-983-9001
Mailing address:
  • Phone: 209-983-9000
  • Fax: 209-983-9001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. JANA M ANSLINGER
Title or Position: MANAGER
Credential:
Phone: 209-814-7262