Provider Demographics
NPI:1245583749
Name:CASTAIC URGENT CARE, INC.
Entity Type:Organization
Organization Name:CASTAIC URGENT CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO / OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:805-253-6708
Mailing Address - Street 1:31905 CASTAIC ROAD
Mailing Address - Street 2:
Mailing Address - City:CASTAIC
Mailing Address - State:CA
Mailing Address - Zip Code:91384
Mailing Address - Country:US
Mailing Address - Phone:661-294-0700
Mailing Address - Fax:661-294-0701
Practice Address - Street 1:31905 CASTAIC ROAD
Practice Address - Street 2:
Practice Address - City:CASTAIC
Practice Address - State:CA
Practice Address - Zip Code:91384
Practice Address - Country:US
Practice Address - Phone:661-294-0700
Practice Address - Fax:661-294-0701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-22
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207Q00000X
CAG82000208800000X
261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty