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General NPI Number Information
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NPI Number | 1205203882
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Entity Type | Organization
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Legal Business Name | BLACK ROCK MEDICAL CARE, INC.
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Dates
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Enumeration Date | 08/30/2015
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Last Update Date | 08/17/2022
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Provider Practice Location Address
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Address Line | 23929 MCBEAN PKWY STE 102
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City | VALENCIA
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State | CA
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Zip | 91355-4467
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Country | US
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Telephone | 661-200-2500
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Fax | 661-200-2504
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Provider Business Mailing Address
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Address Line | 23929 MCBEAN PKWY STE 102
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City | VALENCIA
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State | CA
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Zip | 91355-4467
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Country | US
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Telephone | 661-200-2500
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Fax | 661-200-2504
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Authorized Official
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Title or Position | OWNER
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Name | DR. TRACY NORMAN LAWRENCE
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Credential | MD
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Telephone | 661-200-2500
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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 | 545129
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License Number State | CA
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