Provider Demographics
NPI:1821239237
Name:UNIVERSAL MEDICAL CLINIC, LLP
Entity Type:Organization
Organization Name:UNIVERSAL MEDICAL CLINIC, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CORPORATION PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:MUCHAHARIYAJ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-519-0757
Mailing Address - Street 1:2330 FRUITRIDGE RD STE 3
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95822-3156
Mailing Address - Country:US
Mailing Address - Phone:916-519-0757
Mailing Address - Fax:
Practice Address - Street 1:7275 E SOUTHGATE DR STE 102
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-2610
Practice Address - Country:US
Practice Address - Phone:916-519-0757
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-13
Last Update Date:2009-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care