MEDICARE: UNIVERSAL CITY MEDICAL GROUP, INC.

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	208100000X	Physical Medicine & Rehabilitation Physician	A28549	CA

General Provider Information

NPI Number	:	1326295684
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSAL CITY MEDICAL GROUP, INC.

Provider Business Mailing Address
First Line	:	3535 CAHUENGA BLVD W STE 208
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90068-1359
Country	:	US
Telephone Number	:	323-436-0303
Fax Number	:	323-436-0306

Provider Business Practice Location Address
First Line	:	3535 CAHUENGA BLVD W STE 208
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90068-1359
Country	:	US
Telephone Number	:	323-436-0303
Fax Number	:	323-436-0306

Authorized Official
Title or Position	:	OWNER
Name	:	DAVID MARK REKAR
Credential	:	MD
Telephone Number	:	323-436-0303

Provider Enumeration Date	:	08/19/2008
Last Update Date	:	08/19/2008

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