Provider Demographics
NPI:1477647386
Name:NAGASAMUDRA S ASHOK MD INC
Entity Type:Organization
Organization Name:NAGASAMUDRA S ASHOK MD INC
Other - Org Name:SAN JACINTO FAMILY URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NAGASAMUDRA
Authorized Official - Middle Name:S
Authorized Official - Last Name:ASHOK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-487-2550
Mailing Address - Street 1:229 W 7TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN JACINTO
Mailing Address - State:CA
Mailing Address - Zip Code:92583-4662
Mailing Address - Country:US
Mailing Address - Phone:951-487-2550
Mailing Address - Fax:951-487-2552
Practice Address - Street 1:229 W 7TH ST
Practice Address - Street 2:
Practice Address - City:SAN JACINTO
Practice Address - State:CA
Practice Address - Zip Code:92583-4662
Practice Address - Country:US
Practice Address - Phone:951-487-2550
Practice Address - Fax:951-487-2552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA41589261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A415890Medicaid
CAA29414Medicare UPIN