Provider Demographics
NPI:1275784324
Name:FAMILY URGENT CARE & INDUSTRIAL MEDICAL CLINIC, INC.
Entity Type:Organization
Organization Name:FAMILY URGENT CARE & INDUSTRIAL MEDICAL CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:E
Authorized Official - Last Name:FISHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-808-2828
Mailing Address - Street 1:16661 VENTURA BLVD.
Mailing Address - Street 2:SUITE 108
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-1902
Mailing Address - Country:US
Mailing Address - Phone:818-808-2828
Mailing Address - Fax:818-788-0386
Practice Address - Street 1:16661 VENTURA BLVD.
Practice Address - Street 2:SUITE 108
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-1902
Practice Address - Country:US
Practice Address - Phone:818-808-2828
Practice Address - Fax:818-788-0386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-07
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X
CAFNP24261261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty