Healthcare Provider Details

I. General information

NPI: 1659947455
Provider Name (Legal Business Name): PENINSULA URGENT CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2021
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5001 PACIFIC COAST HIGHWAY
TORRANCE CA
90505
US

IV. Provider business mailing address

5001 PACIFIC COAST HIGHWAY
TORRANCE CA
90505
US

V. Phone/Fax

Practice location:
  • Phone: 310-994-9903
  • Fax: 818-887-4222
Mailing address:
  • Phone: 310-994-9903
  • Fax: 818-887-4222

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: OMER DEEN
Title or Position: OWNER
Credential: MD
Phone: 310-994-5679