Healthcare Provider Details

I. General information

NPI: 1972627586
Provider Name (Legal Business Name): SOUTHLAND FAMILY & URGENT CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 06/07/2024
Certification Date: 02/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27660 SANTA MARGARITA PKWY
MISSION VIEJO CA
92691-6674
US

IV. Provider business mailing address

27660 SANTA MARGARITA PKWY
MISSION VIEJO CA
92691-6674
US

V. Phone/Fax

Practice location:
  • Phone: 949-951-7111
  • Fax: 949-951-2524
Mailing address:
  • Phone: 949-951-7111
  • Fax: 949-951-2524

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA40532
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License NumberA40532
License Number StateCA

VIII. Authorized Official

Name: DR. KONSTANTINOS MELAHOURES
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 949-951-7111