Provider Demographics
NPI:1720821135
Name:UNIVERSAL FAMILY CLINIC LLC
Entity type:Organization
Organization Name:UNIVERSAL FAMILY CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APRN
Authorized Official - Prefix:
Authorized Official - First Name:ORISMELCY
Authorized Official - Middle Name:
Authorized Official - Last Name:DE LOS REYES PUPO
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:813-999-1103
Mailing Address - Street 1:5352 N HABANA AVE STE D
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-6838
Mailing Address - Country:US
Mailing Address - Phone:813-999-1103
Mailing Address - Fax:813-999-1373
Practice Address - Street 1:5352 N HABANA AVE STE D
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-6838
Practice Address - Country:US
Practice Address - Phone:813-999-1103
Practice Address - Fax:813-999-1373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-13
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty