Provider Demographics
NPI:1699399964
Name:UNIVERSAL MEDICAL GROUP & WEIGHT CONTROL CENTER, INC
Entity Type:Organization
Organization Name:UNIVERSAL MEDICAL GROUP & WEIGHT CONTROL CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ARTIS
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODWARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-749-6778
Mailing Address - Street 1:7119 RITA AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90255-4781
Mailing Address - Country:US
Mailing Address - Phone:323-749-6778
Mailing Address - Fax:323-749-6771
Practice Address - Street 1:7119 RITA AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-4781
Practice Address - Country:US
Practice Address - Phone:323-749-6778
Practice Address - Fax:323-749-6771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-03
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA40488OtherMEDICAL BOARD