Provider Demographics
NPI:1972627586
Name:SOUTHLAND FAMILY & URGENT CARE INC
Entity type:Organization
Organization Name:SOUTHLAND FAMILY & URGENT CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KONSTANTINOS
Authorized Official - Middle Name:
Authorized Official - Last Name:MELAHOURES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-951-7111
Mailing Address - Street 1:27660 SANTA MARGARITA PKWY
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6674
Mailing Address - Country:US
Mailing Address - Phone:949-951-7111
Mailing Address - Fax:949-951-2524
Practice Address - Street 1:27660 SANTA MARGARITA PKWY
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6674
Practice Address - Country:US
Practice Address - Phone:949-951-7111
Practice Address - Fax:949-951-2524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA40532208D00000X, 261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW10747Medicare UPIN