Provider Demographics
NPI:1962680033
Name:ANAHEIM URGENT CARE, INC.
Entity Type:Organization
Organization Name:ANAHEIM URGENT CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PEJMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLOURIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-533-2273
Mailing Address - Street 1:1300 N LA BREA AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90028-7504
Mailing Address - Country:US
Mailing Address - Phone:323-464-1336
Mailing Address - Fax:714-635-2273
Practice Address - Street 1:831 S STATE COLLEGE BLVD
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92806-4613
Practice Address - Country:US
Practice Address - Phone:714-533-2273
Practice Address - Fax:714-635-2273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-31
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherTAX ID