Healthcare Provider Details

I. General information

NPI: 1053980086
Provider Name (Legal Business Name): SAN MIGUEL URGENT CARE & INDUSTRIAL CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2021
Last Update Date: 06/23/2021
Certification Date: 06/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 W 9TH ST
SAN BERNARDINO CA
92401-1014
US

IV. Provider business mailing address

404 W 9TH ST
SAN BERNARDINO CA
92401-1014
US

V. Phone/Fax

Practice location:
  • Phone: 909-383-0050
  • Fax:
Mailing address:
  • Phone: 909-383-0050
  • 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: REDA TADROS
Title or Position: CFO
Credential: MD
Phone: 909-383-0050