Healthcare Provider Details

I. General information

NPI: 1952927378
Provider Name (Legal Business Name): ANAHEIM URGENT CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2020
Last Update Date: 06/22/2020
Certification Date: 06/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28900 S. WESTERN AVE
RANCHOS PALOS VERDES CA
90275
US

IV. Provider business mailing address

1300 N LA BREA AVE
LOS ANGELES CA
90028-7504
US

V. Phone/Fax

Practice location:
  • Phone: 424-702-0500
  • Fax:
Mailing address:
  • Phone: 323-464-1336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JAMALA PRATT
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 714-533-2273