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General NPI Number Information
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NPI Number | 1326922170
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Entity Type | Organization
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Legal Business Name | LAKE ELSINORE URGENT CARE CENTER
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Dates
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Enumeration Date | 08/04/2025
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Last Update Date | 08/04/2025
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Provider Practice Location Address
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Address Line | 433 DIAMOND DRIVE SUITE E
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City | LAKE ELSINORE
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State | CA
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Zip | 92530
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Country | US
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Telephone | 951-942-0139
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Fax |
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Provider Business Mailing Address
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Address Line | 9777 WILSHIRE BLVD STE 400
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City | BEVERLY HILLS
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State | CA
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Zip | 90212-1910
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR, BILLING
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Name | WILLIAM VAN NOLL
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Credential |
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Telephone | 818-321-4374
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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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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