Organization
IMPACT CARE ACCESS NETWORK INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PHILIP DIMITRIOS KOUROS M.D. (MEDICAL DOCTOR)
(760) 948-4219
Entity
Organization
Contact information
Practice address
9390 HESPERIA RD, SUITE # 7, HESPERIA, CA 92345-3602
(760) 998-2125
(760) 948-0723
Mailing address
9390 HESPERIA RD, SUITE # 7, HESPERIA, CA 92345-3602
(760) 998-2125
(760) 948-0723
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
G69428
CA
261QU0200X
Urgent Care Clinic/Center
G69428
CA
Other
Enumeration date
01/05/2016
Last updated
01/05/2016
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