Provider Demographics
NPI:1831307651
Name:DV URGENT CARE MEDICAL GROUP INC
Entity Type:Organization
Organization Name:DV URGENT CARE MEDICAL GROUP INC
Other - Org Name:DV URGENT CARE FAMILY PRACTICE & OCCUPATIONAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT MEDICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:VASILE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:909-948-8180
Mailing Address - Street 1:7777 MILLIKEN AVE
Mailing Address - Street 2:A
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-6780
Mailing Address - Country:US
Mailing Address - Phone:909-948-8180
Mailing Address - Fax:909-948-8071
Practice Address - Street 1:7777 MILLIKEN AVE
Practice Address - Street 2:A
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-6780
Practice Address - Country:US
Practice Address - Phone:909-948-8180
Practice Address - Fax:909-948-8071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207Q00000X207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherEMPLOYER ID TID