Healthcare Provider Details

I. General information

NPI: 1932757820
Provider Name (Legal Business Name): UNIVERSAL COMMUNITY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2019
Last Update Date: 09/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2098 S CENTRAL AVE
LOS ANGELES CA
90011-1235
US

IV. Provider business mailing address

2098 S CENTRAL AVE
LOS ANGELES CA
90011-1235
US

V. Phone/Fax

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

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: DIRECTOR OF OPERATIONS
Credential: MHA
Phone: 323-233-3100