| Impact Care Access Network Inc | |
|
9390 Hesperia Rd Suite # 7 Hesperia CA 92345-3602 | |
| (760) 998-2125 | |
| (760) 948-0723 |
| Full Name | Impact Care Access Network Inc |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 9390 Hesperia Rd, Hesperia, California |
| Authorized Official Name and Position | Philip Dimitrios Kouros (MEDICAL DOCTOR) |
| Authorized Official Contact | 7609484219 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Impact Care Access Network Inc 9390 Hesperia Rd Suite # 7 Hesperia CA 92345-3602 Ph: (760) 998-2125 | Impact Care Access Network Inc 9390 Hesperia Rd Suite # 7 Hesperia CA 92345-3602 Ph: (760) 998-2125 |
| NPI Number | 1861858904 |
|---|---|
| Provider Enumeration Date | 01/05/2016 |
| Last Update Date | 01/05/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861858904 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | G69428 (California) | Primary |
| 261QU0200X | Clinic/center - Urgent Care | G69428 (California) | Secondary |
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Impact Care Access Network Ii Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 9390 Hesperia Rd Ste 7, Hesperia, CA 92345 Phone: 760-998-3550 Fax: 760-998-3552 | |