MEDICARE: BRENTWOOD URGENT CARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1053850800
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRENTWOOD URGENT CARE

Provider Business Mailing Address
First Line	:	1156 26TH ST
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90403-4621
Country	:	US
Telephone Number	:	310-829-4505
Fax Number	:

Provider Business Practice Location Address
First Line	:	1156 26TH ST
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90403-4621
Country	:	US
Telephone Number	:	310-829-4505
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	PEJMAN BOLOURIAN
Credential	:	M.D.
Telephone Number	:	310-704-0615

Provider Enumeration Date	:	02/13/2017
Last Update Date	:	02/13/2017

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