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General NPI Number Information
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NPI Number | 1497948194
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Entity Type | Organization
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Legal Business Name | SAN JUAN FAMILY HEALTH URGENT CARE MEDICAL CENTER
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Dates
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Enumeration Date | 08/25/2007
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Last Update Date | 03/11/2015
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Provider Practice Location Address
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Address Line | 32112 CAMINO CAPISTRANO
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City | SAN JUAN CAPISTRANO
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State | CA
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Zip | 92675-3717
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Country | US
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Telephone | 949-248-9797
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Fax | 949-388-3336
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Provider Business Mailing Address
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Address Line | 32112 CAMINO CAPISTRANO
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City | SAN JUAN CAPISTRANO
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State | CA
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Zip | 92675-3717
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Country | US
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Telephone | 949-248-9797
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Fax | 949-388-3336
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Authorized Official
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Title or Position | D.O., PRESIDENT
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Name | MR. SHAHROKH POORMEHR
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Credential | D.O.
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Telephone | 949-248-9797
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 20A6385
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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 | 20A6385
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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 | 20A6385
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License Number State | CA
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