Healthcare Provider Details

I. General information

NPI: 1114963642
Provider Name (Legal Business Name): URDC HUMAN SERVICES CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1460 N LAKE AVE
PASADENA CA
91104-2300
US

IV. Provider business mailing address

1460 N LAKE AVE P.O. BOX 41274
PASADENA CA
91104-2300
US

V. Phone/Fax

Practice location:
  • Phone: 626-398-3796
  • Fax: 626-398-3895
Mailing address:
  • Phone: 626-398-3796
  • Fax: 626-398-3895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License NumberCMM70645F
License Number StateCA

VIII. Authorized Official

Name: DR. AL SORKIN
Title or Position: EXECUTIVE DIRECTOR
Credential: PH.D.
Phone: 626-398-3796