Healthcare Provider Details

I. General information

NPI: 1003226044
Provider Name (Legal Business Name): ANAHEIM URGENT CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2014
Last Update Date: 04/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2006 LINCOLN BLVD
VENICE CA
90291-3949
US

IV. Provider business mailing address

2006 LINCOLN BLVD
VENICE CA
90291-3949
US

V. Phone/Fax

Practice location:
  • Phone: 310-396-2273
  • Fax:
Mailing address:
  • Phone: 310-396-2273
  • 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: DR. PEJMAN BOLOURIAN
Title or Position: SECRETARY
Credential: MD
Phone: 714-533-2273