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General NPI Number Information
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NPI Number | 1578574125
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Entity Type | Organization
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Legal Business Name | RANCHO URGENT CARE PHCY
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Dates
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Enumeration Date | 08/10/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 10841 WHITE OAK AVE STE 101
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-3811
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Country | US
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Telephone | 909-481-7501
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Fax | 909-980-4376
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Provider Business Mailing Address
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Address Line | 10841 WHITE OAK AVE STE 101
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-3811
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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 | MANAGER
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Name | GILBERT OVSEPYAN
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Credential |
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Telephone | 818-653-0404
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHY47439
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License Number State | CA
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