Healthcare Provider Details

I. General information

NPI: 1356394480
Provider Name (Legal Business Name): REGENCY URGENT CARE MEDICAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 10/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1429 COLUSA HWY SUITE B
YUBA CITY CA
95993
US

IV. Provider business mailing address

1429 COLUSA HWY SUITE B
YUBA CITY CA
95993-9092
US

V. Phone/Fax

Practice location:
  • Phone: 530-674-7000
  • Fax: 530-755-3219
Mailing address:
  • Phone: 530-674-7000
  • Fax: 530-755-3219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number4476370001
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License NumberG76223
License Number StateCA

VIII. Authorized Official

Name: DR. FAUFOUINA A AFATO
Title or Position: MEDICAL DIRECTOR CEO
Credential: MD
Phone: 550-674-7000