Healthcare Provider Details

I. General information

NPI: 1386269306
Provider Name (Legal Business Name): UNIVERSAL MOBILE DOCTORS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2020
Last Update Date: 06/16/2020
Certification Date: 06/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15333 SHERMAN WAY STE P
VAN NUYS CA
91406-4204
US

IV. Provider business mailing address

15333 SHERMAN WAY STE P
VAN NUYS CA
91406-4204
US

V. Phone/Fax

Practice location:
  • Phone: 323-821-7772
  • Fax:
Mailing address:
  • Phone: 323-821-7772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. VADIM DANIELIAN
Title or Position: CEO
Credential: FNP, MSN
Phone: 323-821-7772