Provider Demographics
NPI:1144217225
Name:RAPIDCARE URGENT CARE CENTERS/SO CALIF URGENT CARE MEDICAL GROUP
Entity Type:Organization
Organization Name:RAPIDCARE URGENT CARE CENTERS/SO CALIF URGENT CARE MEDICAL GROUP
Other - Org Name:RAPIDCARE GLENDAL
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ARA
Authorized Official - Middle Name:
Authorized Official - Last Name:TAVITIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-265-2200
Mailing Address - Street 1:801 S CHEVY CHASE DR
Mailing Address - Street 2:#105
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-4431
Mailing Address - Country:US
Mailing Address - Phone:818-265-2200
Mailing Address - Fax:818-265-2201
Practice Address - Street 1:801 S CHEVY CHASE DR
Practice Address - Street 2:#105
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-4431
Practice Address - Country:US
Practice Address - Phone:818-265-2200
Practice Address - Fax:818-265-2201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAZZZ47158Z261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ47158ZOtherBLUES
CAW16168Medicare ID - Type Unspecified