Provider Demographics
NPI:1538544010
Name:MEDICAL GROUP URGENT CARE
Entity type:Organization
Organization Name:MEDICAL GROUP URGENT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAHRZAD
Authorized Official - Middle Name:
Authorized Official - Last Name:FORAT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:818-645-8174
Mailing Address - Street 1:3540 WILSHIRE BLVD STE 711
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-2351
Mailing Address - Country:US
Mailing Address - Phone:213-480-6774
Mailing Address - Fax:
Practice Address - Street 1:3540 WILSHIRE BLVD STE 711
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-2351
Practice Address - Country:US
Practice Address - Phone:213-480-6774
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-24
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty