MEDICARE: ANAHEIM URGENT CARE, INC.

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	:	1437716040
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANAHEIM URGENT CARE, INC.

Provider Business Mailing Address
First Line	:	1300 N LA BREA AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90028-7504
Country	:	US
Telephone Number	:	323-464-1336
Fax Number	:

Provider Business Practice Location Address
First Line	:	11600 VENICE BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90066-4014
Country	:	US
Telephone Number	:	310-390-9551
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	JAMALA PRATT
Credential	:
Telephone Number	:	714-533-2273

Provider Enumeration Date	:	05/20/2019
Last Update Date	:	05/20/2019

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