Healthcare Provider Details

I. General information

NPI: 1093023277
Provider Name (Legal Business Name): UNIVERSAL COMMUNITY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2010
Last Update Date: 09/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 E WASHINGTON BLVD SUITE A
LOS ANGELES CA
90021-3020
US

IV. Provider business mailing address

1005 E WASHINGTON BLVD SUITE A
LOS ANGELES CA
90021-3020
US

V. Phone/Fax

Practice location:
  • Phone: 213-745-3636
  • Fax:
Mailing address:
  • Phone: 323-233-3100
  • Fax: 323-233-3124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: EDGAR ALEXANDER CHAVEZ
Title or Position: CEO
Credential: MD
Phone: 323-233-3100