MEDICARE: UVC-CLEAN LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QH0100X	Health Service Clinic/Center
2	225400000X	Rehabilitation Practitioner

General Provider Information

NPI Number	:	1194614982
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UVC-CLEAN LLC

Provider Business Mailing Address
First Line	:	9521 PACIFIC AVE
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92804-5941
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	401 E PACIFIC COAST HWY
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90806-6218
Country	:	US
Telephone Number	:	562-218-1337
Fax Number	:

Authorized Official
Title or Position	:	CELL REJUVENATION SPECIALIST
Name	:	SCOTT CROW
Credential	:
Telephone Number	:	562-218-1337

Provider Enumeration Date	:	06/28/2025
Last Update Date	:	08/17/2025

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