Provider Demographics
NPI:1114638723
Name:UNIVERSITY MUSLIM MEDICAL ASSOCIATION, INC.
Entity Type:Organization
Organization Name:UNIVERSITY MUSLIM MEDICAL ASSOCIATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:STEONEE
Authorized Official - Middle Name:
Authorized Official - Last Name:LASKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-579-1475
Mailing Address - Street 1:711 W FLORENCE AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90044-6105
Mailing Address - Country:US
Mailing Address - Phone:323-789-5610
Mailing Address - Fax:
Practice Address - Street 1:711 W FLORENCE AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90044-6105
Practice Address - Country:US
Practice Address - Phone:323-789-5610
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-06
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health