| Organization Name: | WELLPOINT URGENT CARE LLC |
| NPI Number: | 1114191954 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JAMES PETER DICKENS (PHYSICIAN) |
| Mailing Address: | 3840 El Dorado Hills Blvd Suite 303 El Dorado Hills |
| State: | CA US |
| Postal Code: | 957624567 |
| Phone Number: | 9164577424 |
| Fax Number: | |
| NPI Enumeration Date: | 04/14/2008 |
| NPI Last Update Date: | 04/14/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207QA0505X |
| License Number: | A55172 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Family Medicine |
| Taxonomy Specialization: | Adult Medicine |
| Taxonomy Definition: | |