Provider Demographics
NPI:1063463396
Name:OUCH MEDICAL CENTER
Entity Type:Organization
Organization Name:OUCH MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO PHYSCIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:W
Authorized Official - Last Name:KAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-693-2354
Mailing Address - Street 1:27450 YNEZ RD
Mailing Address - Street 2:#128
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-4680
Mailing Address - Country:US
Mailing Address - Phone:951-693-2354
Mailing Address - Fax:951-693-2356
Practice Address - Street 1:27450 YNEZ RD
Practice Address - Street 2:#128
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-4680
Practice Address - Country:US
Practice Address - Phone:951-693-2354
Practice Address - Fax:951-693-2356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ20927ZMedicare PIN