Provider Demographics
NPI:1396281713
Name:SAN MIGUEL URGENT CARE ANAHEIM A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:SAN MIGUEL URGENT CARE ANAHEIM A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAHFOUZ
Authorized Official - Middle Name:
Authorized Official - Last Name:MICHAEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-494-1331
Mailing Address - Street 1:710 S BROOKHURST ST STE A
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-4321
Mailing Address - Country:US
Mailing Address - Phone:714-494-1331
Mailing Address - Fax:714-494-1332
Practice Address - Street 1:710 S BROOKHURST ST STE A
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-4321
Practice Address - Country:US
Practice Address - Phone:714-494-1331
Practice Address - Fax:714-494-1332
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAN MIGUEL URGENT CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-01-09
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA34248261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0016856Medicaid
CAW7196HMedicare PIN