Provider Demographics
NPI:1699755397
Name:PACIFIC URGENT CARE INC
Entity type:Organization
Organization Name:PACIFIC URGENT CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TAYMOUR
Authorized Official - Middle Name:
Authorized Official - Last Name:MALAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-475-9500
Mailing Address - Street 1:4719 QUAIL LAKES DR
Mailing Address - Street 2:PMB 244 SUITE G
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-5267
Mailing Address - Country:US
Mailing Address - Phone:209-475-9500
Mailing Address - Fax:209-475-9599
Practice Address - Street 1:1782 W HAMMER LN
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95209-2922
Practice Address - Country:US
Practice Address - Phone:209-475-9500
Practice Address - Fax:209-475-9599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-19
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0098260Medicaid
CAZZZ29857ZMedicare ID - Type Unspecified