Healthcare Provider Details

I. General information

NPI: 1497427157
Provider Name (Legal Business Name): UNIVERSAL COMMUNITY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2021
Last Update Date: 10/01/2021
Certification Date: 09/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 S SAN PEDRO ST
LOS ANGELES CA
90011-1121
US

IV. Provider business mailing address

2801 S SAN PEDRO ST
LOS ANGELES CA
90011-2023
US

V. Phone/Fax

Practice location:
  • Phone: 323-233-3100
  • Fax: 323-233-4100
Mailing address:
  • Phone: 323-233-3100
  • Fax: 323-233-4100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: ALFREDO REYNOSO
Title or Position: COO
Credential: MHA
Phone: 323-233-3100