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General NPI Number Information
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NPI Number | 1942428263
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Entity Type | Organization
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Legal Business Name | DR, MIKEL WALK IN CLINIC
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Dates
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Enumeration Date | 04/23/2007
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Last Update Date | 11/30/2010
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Provider Practice Location Address
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Address Line | 15626 HESPERIA RD
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City | VICTORVILLE
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State | CA
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Zip | 92392
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Country | US
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Telephone | 760-949-1231
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Fax | 760-949-1236
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Provider Business Mailing Address
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Address Line | 15791 BEAR VALLEY RD
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City | HESPERIA
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State | CA
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Zip | 92345-1746
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Country | US
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Telephone | 760-949-1231
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Fax | 760-949-1236
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Authorized Official
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Title or Position | PRESIDENT
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Name | MIKEL A ALWIS
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Credential | MD
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Telephone | 760-221-9298
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | A48518
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License Number State | CA
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