Provider Demographics
NPI:1790885895
Name:UNITED MEDICAL ENDOSCOPY CENTER
Entity Type:Organization
Organization Name:UNITED MEDICAL ENDOSCOPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:UDAYA
Authorized Official - Middle Name:
Authorized Official - Last Name:DESILVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-206-0555
Mailing Address - Street 1:1753 A WEST AVENUE J
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534
Mailing Address - Country:US
Mailing Address - Phone:661-206-0555
Mailing Address - Fax:661-206-0558
Practice Address - Street 1:1753 A WEST AVENUE J
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534
Practice Address - Country:US
Practice Address - Phone:661-206-0555
Practice Address - Fax:661-206-0558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5500000201261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASUR01730FMedicaid
CASUR01730FMedicaid