Provider Demographics
NPI:1376632877
Name:UNIVERSAL CARE
Entity Type:Organization
Organization Name:UNIVERSAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:DONALD
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:562-981-4008
Mailing Address - Street 1:1600 E HILL STREET
Mailing Address - Street 2:
Mailing Address - City:SIGNAL HILL
Mailing Address - State:CA
Mailing Address - Zip Code:90755-3682
Mailing Address - Country:US
Mailing Address - Phone:562-424-6200
Mailing Address - Fax:
Practice Address - Street 1:2360 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-3051
Practice Address - Country:US
Practice Address - Phone:562-981-6865
Practice Address - Fax:562-595-6471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAKNOXKEENE9330209208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0019111Medicaid
CAGR0019111Medicaid