Healthcare Provider Details

I. General information

NPI: 1497948194
Provider Name (Legal Business Name): SAN JUAN FAMILY HEALTH URGENT CARE MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2007
Last Update Date: 03/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32112 CAMINO CAPISTRANO
SAN JUAN CAPISTRANO CA
92675-3717
US

IV. Provider business mailing address

32112 CAMINO CAPISTRANO
SAN JUAN CAPISTRANO CA
92675-3717
US

V. Phone/Fax

Practice location:
  • Phone: 949-248-9797
  • Fax: 949-388-3336
Mailing address:
  • Phone: 949-248-9797
  • Fax: 949-388-3336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A6385
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number20A6385
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number20A6385
License Number StateCA

VIII. Authorized Official

Name: MR. SHAHROKH POORMEHR
Title or Position: D.O., PRESIDENT
Credential: D.O.
Phone: 949-248-9797