Provider Demographics
NPI:1053980086
Name:SAN MIGUEL URGENT CARE & INDUSTRIAL CLINIC
Entity type:Organization
Organization Name:SAN MIGUEL URGENT CARE & INDUSTRIAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:REDA
Authorized Official - Middle Name:
Authorized Official - Last Name:TADROS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-383-0050
Mailing Address - Street 1:404 W 9TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92401-1014
Mailing Address - Country:US
Mailing Address - Phone:909-383-0050
Mailing Address - Fax:
Practice Address - Street 1:404 W 9TH ST
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92401-1014
Practice Address - Country:US
Practice Address - Phone:909-383-0050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-23
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care