Provider Demographics
NPI:1811497233
Name:UNIVERSAL FAMILY HEALTHCARE INC
Entity type:Organization
Organization Name:UNIVERSAL FAMILY HEALTHCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALFRED
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:GLOVER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:310-435-3593
Mailing Address - Street 1:18375 VENTURA BLVD STE 747
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-4218
Mailing Address - Country:US
Mailing Address - Phone:914-979-6158
Mailing Address - Fax:323-433-9177
Practice Address - Street 1:5504 PACIFIC BLVD STE F
Practice Address - Street 2:
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-2500
Practice Address - Country:US
Practice Address - Phone:914-979-6158
Practice Address - Fax:323-433-9177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-13
Last Update Date:2018-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4238213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty