Healthcare Provider Details

I. General information

NPI: 1922299346
Provider Name (Legal Business Name): UNIVERSAL CITY MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2007
Last Update Date: 12/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 CAHUENGA BLVD W STE 208
LOS ANGELES CA
90068-1359
US

IV. Provider business mailing address

3535 CAHUENGA BLVD W STE 208
LOS ANGELES CA
90068-1359
US

V. Phone/Fax

Practice location:
  • Phone: 323-436-0303
  • Fax: 323-436-0306
Mailing address:
  • Phone: 323-436-0303
  • Fax: 323-436-0306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberG50815
License Number StateCA

VIII. Authorized Official

Name: DR. DAVID MARK REKAR
Title or Position: OWNER
Credential: M.D.
Phone: 323-436-0303