Healthcare Provider Details

I. General information

NPI: 1376632877
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: 07/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2360 PACIFIC AVE
LONG BEACH CA
90806-3051
US

IV. Provider business mailing address

1600 E HILL STREET
SIGNAL HILL CA
90755-3682
US

V. Phone/Fax

Practice location:
  • Phone: 562-981-6865
  • Fax: 562-595-6471
Mailing address:
  • Phone: 562-424-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberKNOXKEENE9330209
License Number StateCA

VIII. Authorized Official

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