Provider Demographics
NPI:1477866010
Name:AIRPORT URGENT CARE & INDUSTRIAL MEDICINE A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:AIRPORT URGENT CARE & INDUSTRIAL MEDICINE A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMSHID
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:SHARIATI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-215-3555
Mailing Address - Street 1:1117 W MANCHESTER BLVD
Mailing Address - Street 2:#K
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-1500
Mailing Address - Country:US
Mailing Address - Phone:310-215-3555
Mailing Address - Fax:310-215-3587
Practice Address - Street 1:1117 W MANCHESTER BLVD
Practice Address - Street 2:K
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-1500
Practice Address - Country:US
Practice Address - Phone:310-215-3555
Practice Address - Fax:310-215-3587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-25
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care