Provider Demographics
NPI:1184308454
Name:STAR MOBILE URGENT CARE PC
Entity type:Organization
Organization Name:STAR MOBILE URGENT CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:714-785-3639
Mailing Address - Street 1:700 S FLOWER ST STE 1000
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-4112
Mailing Address - Country:US
Mailing Address - Phone:714-785-3639
Mailing Address - Fax:
Practice Address - Street 1:700 S FLOWER ST STE 1000
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-4112
Practice Address - Country:US
Practice Address - Phone:714-785-3639
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-14
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care