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General NPI Number Information
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NPI Number | 1164689048
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Entity Type | Organization
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Legal Business Name | SAN MIGUEL URGENT CARE
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Dates
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Enumeration Date | 05/19/2008
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Last Update Date | 09/04/2024
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Provider Practice Location Address
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Address Line | 2638 E FLORENCE AVE STE D
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City | HUNTINGTON PARK
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State | CA
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Zip | 90255-4708
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Country | US
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Telephone | 323-588-3800
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Fax | 323-277-0399
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Provider Business Mailing Address
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Address Line | 2638 E FLORENCE AVE STE D
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City | HUNTINGTON PARK
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State | CA
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Zip | 90255-4708
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Country | US
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Telephone | 323-588-3800
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SEPEHR KATIRAIE
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Credential | M.D.
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Telephone | 323-588-3800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | A54478
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License Number State | CA
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