Provider Demographics
NPI:1669851085
Name:UMANSKY MEDICAL MANAGEMENT, INC.
Entity Type:Organization
Organization Name:UMANSKY MEDICAL MANAGEMENT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:S
Authorized Official - Last Name:UMANSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-550-9697
Mailing Address - Street 1:4150 REGENTS PARK ROW
Mailing Address - Street 2:SIUTE #260
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-9124
Mailing Address - Country:US
Mailing Address - Phone:858-550-9697
Mailing Address - Fax:858-550-9698
Practice Address - Street 1:4150 REGENTS PARK ROW
Practice Address - Street 2:SIUTE #260
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-9124
Practice Address - Country:US
Practice Address - Phone:858-550-9697
Practice Address - Fax:858-550-9698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-19
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1568716728OtherGROUP NPI
CAGX766ZOtherMEDICARE INDIVIDUAL PTAN
CA1619048261OtherINDIVIDUAL NPI
CA1619048261OtherINDIVIDUAL NPI