Provider Demographics
NPI:1699926485
Name:FAMILY URGENT CARE & INDUSTRIAL MEDICAL CLINIC, INC.
Entity type:Organization
Organization Name:FAMILY URGENT CARE & INDUSTRIAL MEDICAL CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:E
Authorized Official - Last Name:FISHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-808-2828
Mailing Address - Street 1:15450 VENTURA BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-3000
Mailing Address - Country:US
Mailing Address - Phone:818-808-2828
Mailing Address - Fax:818-788-0386
Practice Address - Street 1:412 W AVENUE J
Practice Address - Street 2:SUITE D
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-3685
Practice Address - Country:US
Practice Address - Phone:661-729-4336
Practice Address - Fax:661-723-7635
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAMILY URGENT CARE & INDUSTRIAL MEDICAL CLINIC, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-10
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAFNP24261261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center