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General NPI Number Information
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NPI Number | 1083940597
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Entity Type | Organization
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Legal Business Name | OC URGENTCARE MEDICAL GROUP INCORPORATED
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Dates
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Enumeration Date | 10/19/2009
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Last Update Date | 12/06/2023
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Provider Practice Location Address
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Address Line | 631 S BROOKHURST ST STE 101
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City | ANAHEIM
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State | CA
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Zip | 92804-3563
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Country | US
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Telephone | 714-991-5700
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Fax | 714-991-5800
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Provider Business Mailing Address
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Address Line | PO BOX 2638
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City | ANAHEIM
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State | CA
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Zip | 92814-0638
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Country | US
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Telephone | 714-991-5700
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Fax | 714-991-5800
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Authorized Official
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Title or Position | CFO
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Name | MOUSTAFA OTHMAN
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Credential |
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Telephone | 248-508-6131
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number | BUS2009-03901
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License Number State | CA
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