Provider Demographics
NPI:1578186144
Name:UNIVERSAL COMMUNITY HEALTH CENTER
Entity Type:Organization
Organization Name:UNIVERSAL COMMUNITY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:ALFREDO
Authorized Official - Middle Name:
Authorized Official - Last Name:REYNOSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-313-5588
Mailing Address - Street 1:2801 S SAN PEDRO ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90011-2023
Mailing Address - Country:US
Mailing Address - Phone:323-313-5588
Mailing Address - Fax:323-233-3124
Practice Address - Street 1:900 E 33RD ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90011-2524
Practice Address - Country:US
Practice Address - Phone:232-333-3100
Practice Address - Fax:323-233-4100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-18
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA550003832Medicaid