Provider Demographics
NPI:1336589621
Name:PACOIMA URGENT CARE
Entity Type:Organization
Organization Name:PACOIMA URGENT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NADER
Authorized Official - Middle Name:
Authorized Official - Last Name:JAVADI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-686-2030
Mailing Address - Street 1:13003 VAN NUYS BLVD
Mailing Address - Street 2:SUITE I
Mailing Address - City:PACOIMA
Mailing Address - State:CA
Mailing Address - Zip Code:91331-8316
Mailing Address - Country:US
Mailing Address - Phone:818-686-2030
Mailing Address - Fax:818-834-0099
Practice Address - Street 1:13003 VAN NUYS BLVD
Practice Address - Street 2:SUITE I
Practice Address - City:PACOIMA
Practice Address - State:CA
Practice Address - Zip Code:91331-8316
Practice Address - Country:US
Practice Address - Phone:818-686-2030
Practice Address - Fax:818-834-0099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-01
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC21323111N00000X
CAAC11267171100000X
CAA67700207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty