Provider Demographics
NPI:1962428060
Name:CENTRAL AVENUE URGENT CARE CENTER
Entity type:Organization
Organization Name:CENTRAL AVENUE URGENT CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVIN-BOHLKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-865-9829
Mailing Address - Street 1:8891 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:CA
Mailing Address - Zip Code:91763-1618
Mailing Address - Country:US
Mailing Address - Phone:909-865-9977
Mailing Address - Fax:909-624-0560
Practice Address - Street 1:8891 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:CA
Practice Address - Zip Code:91763-1618
Practice Address - Country:US
Practice Address - Phone:909-865-9977
Practice Address - Fax:909-624-0560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ12125ZMedicare ID - Type UnspecifiedMEDICARE PROVIDER #