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General NPI Number Information
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NPI Number | 1780988915
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Entity Type | Organization
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Legal Business Name | AAA URGENT CARE LLC
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Dates
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Enumeration Date | 01/03/2011
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Last Update Date | 01/03/2011
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Provider Practice Location Address
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Address Line | 14400 ROSCOE BLVD SUITE D
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City | PANORAMA CITY
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State | CA
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Zip | 91402-3001
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Country | US
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Telephone | 818-893-5819
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Fax | 818-830-8421
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Provider Business Mailing Address
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Address Line | 14400 ROSCOE BLVD SUITED
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City | PANORAMA CITY
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State | CA
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Zip | 91402-3001
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Country | US
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Telephone | 818-893-5819
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Fax | 818-830-8421
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Authorized Official
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Title or Position | CEO
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Name | YAROSLAV S GOFNUNG
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Credential | M.D.
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Telephone | 818-893-5819
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A81752
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | A81752
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | A81752
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License Number State | CA
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