MEDICARE: UNIVERSAL MOBILE DOCTORS 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	207QA0505X	Adult Medicine Physician

General Provider Information

NPI Number	:	1386269306
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSAL MOBILE DOCTORS INC

Provider Business Mailing Address
First Line	:	15333 SHERMAN WAY STE P
Second Line	:
City	:	VAN NUYS
State	:	CA
Zip	:	91406-4204
Country	:	US
Telephone Number	:	323-821-7772
Fax Number	:

Provider Business Practice Location Address
First Line	:	15333 SHERMAN WAY STE P
Second Line	:
City	:	VAN NUYS
State	:	CA
Zip	:	91406-4204
Country	:	US
Telephone Number	:	323-821-7772
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. VADIM DANIELIAN
Credential	:	FNP, MSN
Telephone Number	:	323-821-7772

Provider Enumeration Date	:	06/16/2020
Last Update Date	:	06/16/2020

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