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General NPI Number Information
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NPI Number | 1659870459
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Entity Type | Organization
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Legal Business Name | CALIFORNIA CORPORATION USMD DIRECT, INC
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Dates
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Enumeration Date | 02/07/2018
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Last Update Date | 02/07/2018
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Provider Practice Location Address
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Address Line | 2021 SANTA MONICA BLVD STE 710E
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City | SANTA MONICA
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State | CA
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Zip | 90404-2208
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Country | US
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Telephone | 310-449-1415
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Fax |
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Provider Business Mailing Address
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Address Line | 2021 SANTA MONICA BLVD STE 710E
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City | SANTA MONICA
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State | CA
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Zip | 90404-2208
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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 | PRESIDENT
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Name | FAWAD ZAFAR-KHAN
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Credential | MC
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Telephone | 818-489-4030
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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 | C3440352
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License Number State | CA
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