Healthcare Provider Details

I. General information

NPI: 1104757145
Provider Name (Legal Business Name): STATELY URGENT CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1467 FORD ST STE 201
REDLANDS CA
92373-3912
US

IV. Provider business mailing address

1467 FORD ST STE 201
REDLANDS CA
92373-3912
US

V. Phone/Fax

Practice location:
  • Phone: 909-712-0414
  • Fax:
Mailing address:
  • Phone: 909-712-0414
  • 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: DR. SALMA GREEN
Title or Position: PHYSICIAN/CEO/OWNER
Credential: DO
Phone: 909-712-0414