1881468502 NPI number — UNIVERSAL PSYCHIATRY AND ADDICTION CARE SERVICES

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881468502 NPI number — UNIVERSAL PSYCHIATRY AND ADDICTION CARE SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSAL PSYCHIATRY AND ADDICTION CARE SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1881468502
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/13/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
905 DICKSON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARINA DEL REY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90292-5512
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15523 COLLINA STRADA
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90077-1513
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
747-249-4383
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/13/2023

Additional Information

Authorized Official

Authorized Official Last Name:
HUMMEL
Authorized Official First Name:
LEA
Authorized Official Middle Name:
Authorized Official Title or Position:
SECRETARY
Authorized Official Telephone Number:
747-888-7911

Provider Taxonomy Codes

  • Taxonomy code: 261QM0850X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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