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Organization
SOUTH COUNTY URGENT CARE MEDICAL CORPORATION
Active
Organization
SOUTH COUNTY URGENT CARE MEDICAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN GENTILE M.D. (CEO)
(949) 218-8050
Entity
Organization
Contact information
Practice address
1300 AVENIDA VISTA HERMOSA, #100, SAN CLEMENTE, CA 92673-6315
(949) 218-8050
(949) 218-8051
Mailing address
1300 AVENIDA VISTA HERMOSA, #100, SAN CLEMENTE, CA 92673-6315
(949) 218-8050
(949) 218-8051
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
FNP30274
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZZ05603Z
BLUE SHIELD
CA
Enumeration date
05/18/2007
Last updated
03/26/2018
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