Provider Demographics
NPI:1073987095
Name:UNIVERSAL HEALTHCARE PROFESSIONAL MEDICAL PC
Entity Type:Organization
Organization Name:UNIVERSAL HEALTHCARE PROFESSIONAL MEDICAL PC
Other - Org Name:AMERICANS FOR BETTER HEALTH MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DERRICK
Authorized Official - Middle Name:M
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-804-3031
Mailing Address - Street 1:90 N MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-1740
Mailing Address - Country:US
Mailing Address - Phone:626-291-2525
Mailing Address - Fax:626-898-9244
Practice Address - Street 1:90 N MADISON AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-1740
Practice Address - Country:US
Practice Address - Phone:626-291-2525
Practice Address - Fax:626-898-9244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-16
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA545378207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty