Provider Demographics
NPI:1134142524
Name:AFATO MEDICAL CORPORATION
Entity Type:Organization
Organization Name:AFATO MEDICAL CORPORATION
Other - Org Name:REGENCY URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FA'AFOUINA
Authorized Official - Middle Name:S
Authorized Official - Last Name:AFATO
Authorized Official - Suffix:IV
Authorized Official - Credentials:MD
Authorized Official - Phone:530-755-3218
Mailing Address - Street 1:1429 COLUSA HWY STE B
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95993-9092
Mailing Address - Country:US
Mailing Address - Phone:530-755-3218
Mailing Address - Fax:530-755-3219
Practice Address - Street 1:1429 COLUSA HWY STE B
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95993-9092
Practice Address - Country:US
Practice Address - Phone:530-755-3218
Practice Address - Fax:530-755-3219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG76223207Q00000X
CA4476370001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05D0999042OtherCOLA
CA05D0999042OtherCOLA
CAZZZ22462ZMedicare Oscar/Certification