Provider Demographics
NPI:1780083238
Name:VICTORIA URGENT CARE CLINIC
Entity type:Organization
Organization Name:VICTORIA URGENT CARE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAKESH
Authorized Official - Middle Name:
Authorized Official - Last Name:JINDAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-781-3931
Mailing Address - Street 1:332 N VILLA ST
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-3211
Mailing Address - Country:US
Mailing Address - Phone:559-781-3931
Mailing Address - Fax:559-781-7805
Practice Address - Street 1:1900 S VICTORIA AVE
Practice Address - Street 2:STE C
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-6644
Practice Address - Country:US
Practice Address - Phone:805-676-0010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RAKESH JINDAL M.D.INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-08-21
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA32366207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA544127OtherFICTITIOUS NAME PERMIT