Provider Demographics
NPI:1558746750
Name:SOUTHBAY URGENT CARE INC
Entity Type:Organization
Organization Name:SOUTHBAY URGENT CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEKER DICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:619-591-9999
Mailing Address - Street 1:1628 PALM AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92154-1027
Mailing Address - Country:US
Mailing Address - Phone:619-591-9999
Mailing Address - Fax:
Practice Address - Street 1:555 SATURN BLVD
Practice Address - Street 2:SUITE B BOX 292
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92154-4766
Practice Address - Country:US
Practice Address - Phone:619-591-9999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-29
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care