Provider Demographics
NPI:1760599237
Name:AVALON URGENT CARE INC
Entity Type:Organization
Organization Name:AVALON URGENT CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RUI
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:DA SILVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-365-0851
Mailing Address - Street 1:58471 29 PALMS HWY
Mailing Address - Street 2:SUITE 303
Mailing Address - City:YUCCA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92284-5818
Mailing Address - Country:US
Mailing Address - Phone:760-365-0851
Mailing Address - Fax:760-365-6848
Practice Address - Street 1:58471 29 PALMS HWY
Practice Address - Street 2:SUITE 303
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284-5818
Practice Address - Country:US
Practice Address - Phone:760-365-0851
Practice Address - Fax:760-365-6848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2009-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA89717207R00000X
CAG36975207R00000X
CAA33298208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G369750Medicaid
CA00A332980Medicaid
CA00A897170Medicaid
CAA332980OtherLIC
CAZZZ11547ZOtherMEDICARE ID
CAA332980OtherLIC
CAI30599Medicare UPIN
CA00G369750Medicaid
CAZZZ11547ZOtherMEDICARE ID
CA00A897170Medicare PIN
CAA27102Medicare UPIN
CA00A332980Medicare PIN