1487017232 NPI number — UNIVERSA MEDICA HEALTH INC

Table of content: (NPI 1487017232)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487017232 NPI number — UNIVERSA MEDICA HEALTH INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSA MEDICA HEALTH INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487017232
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/28/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O BOX 1674
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANTA ANA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92702-1674
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-480-6800
Provider Business Mailing Address Fax Number:
714-480-9285

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1125 E 17TH STREET
Provider Second Line Business Practice Location Address:
SUITE 106
Provider Business Practice Location Address City Name:
SANTA ANA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92701-2201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-480-6800
Provider Business Practice Location Address Fax Number:
714-480-9285
Provider Enumeration Date:
03/30/2016

Additional Information

Authorized Official

Authorized Official Last Name:
SANCHEZ
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
ANAYA
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
714-480-6800

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  A55647 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00A556470 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com