Healthcare Provider Details

I. General information

NPI: 1730570763
Provider Name (Legal Business Name): IMMEDIATE HEALTHCARE CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2015
Last Update Date: 02/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11507 OXNARD ST # 3
NORTH HOLLYWOOD CA
91606-4809
US

IV. Provider business mailing address

11507 OXNARD ST # 3
NORTH HOLLYWOOD CA
91606-4809
US

V. Phone/Fax

Practice location:
  • Phone: 323-633-9760
  • Fax:
Mailing address:
  • Phone: 323-633-9760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateCA

VIII. Authorized Official

Name: MR. ARLENE TORRES FABIAN
Title or Position: PRESIDENT
Credential: FNP-C
Phone: 323-633-9760