Provider Demographics
NPI:1770396723
Name:SPECIALIZED URGENT CARE
Entity type:Organization
Organization Name:SPECIALIZED URGENT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:FARIBA
Authorized Official - Middle Name:R
Authorized Official - Last Name:SHOKOOHY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-380-8203
Mailing Address - Street 1:17342 ALMELO LN
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92649-4621
Mailing Address - Country:US
Mailing Address - Phone:714-768-0090
Mailing Address - Fax:
Practice Address - Street 1:7710 LIMONITE AVE STE 101
Practice Address - Street 2:
Practice Address - City:JURUPA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92509-5342
Practice Address - Country:US
Practice Address - Phone:714-768-0090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-31
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1962694869Medicaid