Organization Name: | JACKNOLIA URGENT CARE |
NPI Number: | 1174981906 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JENNIFER CHAPMAN (ADMINISTRATOR) |
Mailing Address: | 9041 Magnolia Ave Suite 107 Riverside |
State: | CA US |
Postal Code: | 925033900 |
Phone Number: | 9513531021 |
Fax Number: | |
NPI Enumeration Date: | 02/08/2016 |
NPI Last Update Date: | 02/08/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |