Healthcare Provider Details

I. General information

NPI: 1215365754
Provider Name (Legal Business Name): MORENO VALLEY URGENT CARE CLINIC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2013
Last Update Date: 10/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1744 UNIVERSITY AVE SUITE 100
RIVERSIDE CA
92507-5364
US

IV. Provider business mailing address

24318 HEMLOCK AVE SUITE E1
MORENO VALLEY CA
92557-7222
US

V. Phone/Fax

Practice location:
  • Phone: 951-243-5586
  • Fax: 951-243-5050
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License NumberA4349
License Number StateCA

VIII. Authorized Official

Name: DR. JAMES ALVIN HARRISON
Title or Position: PRESIDNET / CEO
Credential: MD
Phone: 951-243-5050