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General NPI Number Information
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NPI Number | 1245583749
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Entity Type | Organization
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Legal Business Name | CASTAIC URGENT CARE, INC.
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Dates
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Enumeration Date | 10/22/2012
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Last Update Date | 12/19/2012
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Provider Practice Location Address
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Address Line | 31905 CASTAIC ROAD
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City | CASTAIC
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State | CA
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Zip | 91384
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Country | US
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Telephone | 661-294-0700
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Fax | 661-294-0701
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Provider Business Mailing Address
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Address Line | 31905 CASTAIC ROAD
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City | CASTAIC
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State | CA
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Zip | 91384
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Country | US
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Telephone | 661-294-0700
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Fax | 661-294-0701
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Authorized Official
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Title or Position | COO / OWNER
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Name | MR. LEE JACKSON JR.
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Credential |
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Telephone | 805-253-6708
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | G82000
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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