Basic Information
| Provider Information | |||||||||
| NPI: | 1689265407 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UPPERLINE HEALTHCARE CALIFORNIA, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 102 WOODMONT BLVD STE 450 | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372055202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6156272193 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9017 RESEDA BLVD STE 100 | ||||||||
| Address2: | |||||||||
| City: | NORTHRIDGE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913243969 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8188858400 | ||||||||
| FaxNumber: | 8188481872 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/03/2021 | ||||||||
| LastUpdateDate: | 02/03/2021 | ||||||||
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| AuthorizedOfficialLastName: | KING | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5086795700 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 02/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0103X | Y | 193200000X MULTI-SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
No ID Information.