Provider Demographics
NPI:1922299346
Name:UNIVERSAL CITY MEDICAL GROUP INC
Entity Type:Organization
Organization Name:UNIVERSAL CITY MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:REKAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-436-0303
Mailing Address - Street 1:3535 CAHUENGA BLVD W STE 208
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90068-1359
Mailing Address - Country:US
Mailing Address - Phone:323-436-0303
Mailing Address - Fax:323-436-0306
Practice Address - Street 1:3535 CAHUENGA BLVD W STE 208
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90068-1359
Practice Address - Country:US
Practice Address - Phone:323-436-0303
Practice Address - Fax:323-436-0306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-09
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG50815208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG48134Medicare UPIN