Provider Demographics
NPI:1730894148
Name:OC URGENTCARE MEDICAL GROUP, INC
Entity type:Organization
Organization Name:OC URGENTCARE MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NAHLA
Authorized Official - Middle Name:H
Authorized Official - Last Name:SALEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-508-6131
Mailing Address - Street 1:PO BOX 2638
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92814-0638
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:23653 EL TORO RD STE B
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-8614
Practice Address - Country:US
Practice Address - Phone:949-317-0312
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OC URGENTCARE MEDICAL GROUP, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-01-19
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADB088AOtherMEDICARE PTAN