Healthcare Provider Details

I. General information

NPI: 1962428060
Provider Name (Legal Business Name): CENTRAL AVENUE URGENT CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8891 CENTRAL AVE
MONTCLAIR CA
91763-1618
US

IV. Provider business mailing address

8891 CENTRAL AVE
MONTCLAIR CA
91763-1618
US

V. Phone/Fax

Practice location:
  • Phone: 909-865-9977
  • Fax: 909-624-0560
Mailing address:
  • Phone: 909-865-9977
  • Fax: 909-624-0560

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: KAREN LEVIN-BOHLKA
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 909-865-9829