Basic Information
| Provider Information | |||||||||
| NPI: | 1407882608 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | INLAND URGENT CARE A MEDICAL CORPORATION | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | INLAND URGENT CARE WILDOMAR | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 31588 RAILROAD CANYON RD | ||||||||
| Address2: | |||||||||
| City: | CANYON LAKE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925879468 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9514713888 | ||||||||
| FaxNumber: | 9514712965 | ||||||||
| Practice Location | |||||||||
| Address1: | 36320 INLAND VALLEY DR STE 307 | ||||||||
| Address2: | |||||||||
| City: | WILDOMAR | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925957512 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9516000110 | ||||||||
| FaxNumber: | 9516001489 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2006 | ||||||||
| LastUpdateDate: | 04/09/2018 | ||||||||
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| AuthorizedOfficialLastName: | BECK | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | K. | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 9514713888 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QU0200X | CA | Y | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
No ID Information.