Healthcare Provider Details

I. General information

NPI: 1982121307
Provider Name (Legal Business Name): WEST LOS ANGELES URGENT CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2017
Last Update Date: 03/02/2023
Certification Date: 03/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11560 W PICO BLVD
LOS ANGELES CA
90064-1520
US

IV. Provider business mailing address

831 S STATE COLLEGE BLVD
ANAHEIM CA
92806-4613
US

V. Phone/Fax

Practice location:
  • Phone: 310-477-8285
  • Fax:
Mailing address:
  • Phone: 714-533-2273
  • Fax: 714-635-2273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JAMALA PRATT
Title or Position: MANAGER
Credential:
Phone: 714-533-2273