Healthcare Provider Details

I. General information

NPI: 1942428263
Provider Name (Legal Business Name): DR, MIKEL WALK IN CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 11/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15626 HESPERIA RD
VICTORVILLE CA
92392
US

IV. Provider business mailing address

15791 BEAR VALLEY RD
HESPERIA CA
92345-1746
US

V. Phone/Fax

Practice location:
  • Phone: 760-949-1231
  • Fax: 760-949-1236
Mailing address:
  • Phone: 760-949-1231
  • Fax: 760-949-1236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA48518
License Number StateCA

VIII. Authorized Official

Name: MIKEL A ALWIS
Title or Position: PRESIDENT
Credential: MD
Phone: 760-221-9298