Basic Information
Provider Information
NPI: 1134155336
EntityType: 2
ReplacementNPI:  
OrganizationName: INLAND URGENT CARE OF SUN CITY
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: INLAND URGENT CARE MENIFEE
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 31588 RAILROAD CANYON RD
Address2:  
City: CANYON LAKE
State: CA
PostalCode: 925879468
CountryCode: US
TelephoneNumber: 9514713888
FaxNumber: 9514712965
Practice Location
Address1: 27168 NEWPORT RD STE 1
Address2:  
City: MENIFEE
State: CA
PostalCode: 925847383
CountryCode: US
TelephoneNumber: 9512463033
FaxNumber: 9512467373
Other Information
ProviderEnumerationDate: 06/23/2006
LastUpdateDate: 04/13/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: BECK
AuthorizedOfficialFirstName: ROBERT
AuthorizedOfficialMiddleName: K
AuthorizedOfficialTitleorPosition: CEO
AuthorizedOfficialTelephone: 9514713888
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: MD
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
261QU0200X CAY Ambulatory Health Care FacilitiesClinic/CenterUrgent Care

No ID Information.


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