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General NPI Number Information
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NPI Number | 1366834756
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Entity Type | Organization
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Legal Business Name | PROSPECT FOOTHILL URGENT CARE
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Dates
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Enumeration Date | 02/23/2015
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Last Update Date | 03/26/2015
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Provider Practice Location Address
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Address Line | 14642 NEWPORT AVE STE 101
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City | TUSTIN
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State | CA
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Zip | 92780-6058
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Country | US
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Telephone | 714-522-2891
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 11466
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City | SANTA ANA
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State | CA
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Zip | 92711-1466
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Country | US
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Telephone | 714-522-2891
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Fax | 714-903-7801
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Authorized Official
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Title or Position | OWNER
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Name | MITCHELL W LEW
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Credential | MD
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Telephone | 714-813-5129
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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 |
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License Number State |
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