| Organization Name: | EXECUTIVE URGENT CARE OF INDIAN WELLS |
| NPI Number: | 1801181961 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DAVID H TANG (OWNER) |
| Mailing Address: | 74785 Highway 111 Suite 100 Indian Wells |
| State: | CA US |
| Postal Code: | 92210 |
| Phone Number: | 7603463932 |
| Fax Number: | 7603468584 |
| NPI Enumeration Date: | 06/16/2011 |
| NPI Last Update Date: | 06/16/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QU0200X |
| License Number: | G44271 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Urgent Care |
| Taxonomy Definition: | |