Provider Demographics
NPI:1437589769
Name:TEMPLE COMMUNITY CLINIC URGENTCARE
Entity Type:Organization
Organization Name:TEMPLE COMMUNITY CLINIC URGENTCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:
Authorized Official - Last Name:AYBAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-664-4234
Mailing Address - Street 1:3755 BEVERLY BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004-3539
Mailing Address - Country:US
Mailing Address - Phone:323-664-4234
Mailing Address - Fax:323-664-4235
Practice Address - Street 1:3755 BEVERLY BLVD STE 300
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-3539
Practice Address - Country:US
Practice Address - Phone:323-664-4234
Practice Address - Fax:323-664-4235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-22
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG81088261Q00000X, 261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center