Provider Demographics
NPI:1063606663
Name:UNIVERSAL HEALTH RESOURCES
Entity type:Organization
Organization Name:UNIVERSAL HEALTH RESOURCES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOCELYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:EBERSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:310-446-1968
Mailing Address - Street 1:10780 SANTA MONICA BLVD STE 245
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-7633
Mailing Address - Country:US
Mailing Address - Phone:310-446-1968
Mailing Address - Fax:
Practice Address - Street 1:10780 SANTA MONICA BLVD STE 245
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-7633
Practice Address - Country:US
Practice Address - Phone:310-446-1968
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-28
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALAC3016261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center