Provider Demographics
NPI:1326581901
Name:OC URGENTCARE MEDICAL GROUP INCORPORATED
Entity Type:Organization
Organization Name:OC URGENTCARE MEDICAL GROUP INCORPORATED
Other - Org Name:OC URGENT CARE ORANGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NAHLA
Authorized Official - Middle Name:H
Authorized Official - Last Name:SALEM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-991-5700
Mailing Address - Street 1:PO BOX 2638
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92814-0638
Mailing Address - Country:US
Mailing Address - Phone:714-991-5700
Mailing Address - Fax:714-991-5800
Practice Address - Street 1:4720 E CHAPMAN AVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92869-4113
Practice Address - Country:US
Practice Address - Phone:714-771-7600
Practice Address - Fax:714-771-7601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-30
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA106233261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADB088AMedicare PIN