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	:	1619560901
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	:	2968 E FLORENCE AVE
Second Line	:
City	:	HUNTINGTON PARK
State	:	CA
Zip	:	90255-5826
Country	:	US
Telephone Number	:	323-522-9500
Fax Number	:	323-522-9501

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

Provider Enumeration Date	:	02/17/2021
Last Update Date	:	02/17/2021

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