Healthcare Provider Details

I. General information

NPI: 1538827613
Provider Name (Legal Business Name): LUCILLE J UBER, MD, A MEDICAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2021
Last Update Date: 12/06/2021
Certification Date: 12/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 N HOLLYWOOD WAY
BURBANK CA
91505-1826
US

IV. Provider business mailing address

1411 N HOLLYWOOD WAY
BURBANK CA
91505-1826
US

V. Phone/Fax

Practice location:
  • Phone: 818-841-9990
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LUCILLE UBER
Title or Position: CEO
Credential: MD
Phone: 818-744-4694