Provider Demographics
NPI:1790901098
Name:ROBERT G CZAKO, M.D., INC.
Entity Type:Organization
Organization Name:ROBERT G CZAKO, M.D., INC.
Other - Org Name:STAT URGENT CARE MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:CZAKO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:760-837-0321
Mailing Address - Street 1:PO BOX 1029
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92261-1029
Mailing Address - Country:US
Mailing Address - Phone:760-837-0321
Mailing Address - Fax:760-837-9114
Practice Address - Street 1:73211 FRED WARING DR STE 101
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-2871
Practice Address - Country:US
Practice Address - Phone:760-837-0321
Practice Address - Fax:760-837-9114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA038911207R00000X
261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherBLUE CROSS
CA=========OtherBLUE CROSS
CA3888900001Medicare NSC