Healthcare Provider Details

I. General information

NPI: 1003517699
Provider Name (Legal Business Name): SAN MIGUEL URGENT CARE SAN PEDRO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2023
Last Update Date: 03/13/2023
Certification Date: 03/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 W 7TH ST
SAN PEDRO CA
90731-3115
US

IV. Provider business mailing address

PO BOX 291040
LOS ANGELES CA
90029-9040
US

V. Phone/Fax

Practice location:
  • Phone: 424-264-5630
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MAHFOUZ MICHAEL
Title or Position: OWNER
Credential: MD
Phone: 323-999-8267