Provider Demographics
NPI:1043359433
Name:PROCARE WORK INJURY CENTER & URGENT CARE
Entity Type:Organization
Organization Name:PROCARE WORK INJURY CENTER & URGENT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SOLONGO
Authorized Official - Middle Name:
Authorized Official - Last Name:GOMBOSUREN
Authorized Official - Suffix:
Authorized Official - Credentials:BA, MBA
Authorized Official - Phone:949-752-1111
Mailing Address - Street 1:17232 RED HILL AVE
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-5628
Mailing Address - Country:US
Mailing Address - Phone:949-752-1111
Mailing Address - Fax:949-752-1133
Practice Address - Street 1:18582 BEACH BLVD STE 23A
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-2012
Practice Address - Country:US
Practice Address - Phone:714-964-4442
Practice Address - Fax:714-963-3780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA74672207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA74672OtherLICENSE
CAW8237Medicare ID - Type Unspecified