Healthcare Provider Details

I. General information

NPI: 1053400549
Provider Name (Legal Business Name): UNIVERSAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12751 HARBOR BOULEVARD
GARDEN GROVE CA
92840-5800
US

IV. Provider business mailing address

1600 E HILL STREET
SIGNAL HILL CA
90755-3682
US

V. Phone/Fax

Practice location:
  • Phone: 714-636-7852
  • Fax: 714-636-0928
Mailing address:
  • Phone: 562-424-6200
  • Fax: 562-427-4634

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberKNOX-KEENE 933-0209
License Number StateCA

VIII. Authorized Official

Name: JOHN DONALD ADAMS
Title or Position: CHIEF MEDICAL OFFICER
Credential: DO
Phone: 562-981-4008