| Nellie Gail Urgent Care Medical Corp | |
|
27001 Moulton Pkwy Suite A-102 Laguna Hills CA 92656-3626 | |
| (949) 600-1907 | |
| (949) 600-1912 |
| Full Name | Nellie Gail Urgent Care Medical Corp |
|---|---|
| Speciality | Clinic/Center |
| Location | 27001 Moulton Pkwy, Laguna Hills, California |
| Authorized Official Name and Position | Jack Bailey Vu (PHYSICIAN) |
| Authorized Official Contact | 9496001907 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Nellie Gail Urgent Care Medical Corp 27001 Moulton Pkwy Suite A-102 Laguna Hills CA 92656-3626 Ph: (949) 600-1907 | Nellie Gail Urgent Care Medical Corp 27001 Moulton Pkwy Suite A-102 Laguna Hills CA 92656-3626 Ph: (949) 600-1907 |
| NPI Number | 1073909859 |
|---|---|
| Provider Enumeration Date | 04/08/2015 |
| Last Update Date | 09/22/2015 |
| Medicare PECOS PAC ID | 7810203999 |
|---|---|
| Medicare Enrollment ID | O20150903002424 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073909859 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 261QU0200X | Clinic/center - Urgent Care | FNP544683 (California) | Primary |
| Provider Name | Mehrdad Salimkhanian |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1467640888 PECOS PAC ID: 5890876817 Enrollment ID: I20080116000360 |
| Provider Name | Laura Elizabeth Jardine |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902381155 PECOS PAC ID: 5890032197 Enrollment ID: I20190124001671 |
| Provider Name | Kim Sison Anicete |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023596400 PECOS PAC ID: 5496180853 Enrollment ID: I20200114001259 |
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