Provider Demographics
NPI:1417726852
Name:EXPRESS WALK-IN CLINIC
Entity Type:Organization
Organization Name:EXPRESS WALK-IN CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:SCIENEAUX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-523-6205
Mailing Address - Street 1:18182 US HIGHWAY 18 STE 106
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-2200
Mailing Address - Country:US
Mailing Address - Phone:760-515-4003
Mailing Address - Fax:760-515-4503
Practice Address - Street 1:18182 US HIGHWAY 18 STE 106
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-2200
Practice Address - Country:US
Practice Address - Phone:760-515-4003
Practice Address - Fax:760-515-4503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-27
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center