Provider Demographics
NPI:1407090665
Name:LA PALMA URGENT & FAMILY CARE INC.
Entity Type:Organization
Organization Name:LA PALMA URGENT & FAMILY CARE INC.
Other - Org Name:LA PALMA URGENT & FAMILY CARE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SIDDIQ
Authorized Official - Middle Name:AHMED
Authorized Official - Last Name:KHAWAJA
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR
Authorized Official - Phone:714-994-2273
Mailing Address - Street 1:7851 WALKER ST STE 102
Mailing Address - Street 2:
Mailing Address - City:LA PALMA
Mailing Address - State:CA
Mailing Address - Zip Code:90623-1734
Mailing Address - Country:US
Mailing Address - Phone:714-994-2273
Mailing Address - Fax:714-994-2224
Practice Address - Street 1:7851 WALKER ST STE 102
Practice Address - Street 2:
Practice Address - City:LA PALMA
Practice Address - State:CA
Practice Address - Zip Code:90623-1734
Practice Address - Country:US
Practice Address - Phone:714-994-2273
Practice Address - Fax:714-994-2224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-30
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC42493261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
$$$$$$$$$OtherSOCIAL SECURITY
CA00C424931Medicaid
186567913OtherSOCIAL SECURITY