Provider Demographics
NPI:1689815953
Name:LA PALMA URGENT & FAMILY CARE
Entity Type:Organization
Organization Name:LA PALMA URGENT & FAMILY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAHMUNIR
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-994-2273
Mailing Address - Street 1:7851 WALKER ST.
Mailing Address - Street 2:SUITE# 102
Mailing Address - City:LA PALMA
Mailing Address - State:CA
Mailing Address - Zip Code:90623-1734
Mailing Address - Country:US
Mailing Address - Phone:714-994-2273
Mailing Address - Fax:714-994-2224
Practice Address - Street 1:7851 WALKER ST.
Practice Address - Street 2:SUITE# 102
Practice Address - City:LA PALMA
Practice Address - State:CA
Practice Address - Zip Code:90623-1734
Practice Address - Country:US
Practice Address - Phone:714-994-2273
Practice Address - Fax:714-994-2224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-17
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1962305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA126-56-59312OtherNPI
CAC42493OtherMD LICENSE
CAC42493AOtherMEDICARE
CAC42493OtherMD LICENSE