Provider Demographics
NPI:1538645403
Name:SUN VALLEY URGENT CARE
Entity Type:Organization
Organization Name:SUN VALLEY URGENT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:O
Authorized Official - Prefix:
Authorized Official - First Name:A
Authorized Official - Middle Name:
Authorized Official - Last Name:A
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-504-8234
Mailing Address - Street 1:8426 SUNLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:SUN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91352-3436
Mailing Address - Country:US
Mailing Address - Phone:818-504-8234
Mailing Address - Fax:
Practice Address - Street 1:8426 SUNLAND BLVD
Practice Address - Street 2:
Practice Address - City:SUN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91352-3436
Practice Address - Country:US
Practice Address - Phone:818-635-4796
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-13
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1487033213Medicaid