Healthcare Provider Details

I. General information

NPI: 1114240371
Provider Name (Legal Business Name): FAMILY MEDICAL CLINIC & URGENT CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2010
Last Update Date: 12/26/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9723 SIERRA VISTA RD UNIT A
PHELAN CA
92371-8271
US

IV. Provider business mailing address

9723 SIERRA VISTA RD UNIT A
PHELAN CA
92371-8271
US

V. Phone/Fax

Practice location:
  • Phone: 760-868-1990
  • Fax: 760-868-1201
Mailing address:
  • Phone: 760-868-1990
  • Fax: 760-868-1201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberA61054
License Number StateCA

VIII. Authorized Official

Name: VIVEK SINGH GILL
Title or Position: OWNER
Credential: MD
Phone: 760-868-1990