Organization
MEDESTATE INC.
Active
Other names
ExcelCare Immediate Care Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNETH RICHARD BROOKS M.D. (PRESIDENT / CEO)
(707) 645-7229
Entity
Organization
Contact information
Practice address
3431 BROADWAY ST, SUITE A-8, AMERICAN CANYON, CA 94503-1228
(707) 645-7229
(707) 645-7431
Mailing address
3431 BROADWAY ST, SUITE A-8, AMERICAN CANYON, CA 94503-1228
(707) 645-7229
(707) 645-7431
Taxonomy
Speciality
Code
Description
License number
State
261QU0200X
Urgent Care Clinic/Center
Primary
00A0627550
CA
Other
Enumeration date
10/16/2006
Last updated
12/29/2011
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