1770882409 NPI number — REGENTS UNIV OF CALIF LOS ANGELES

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 1770882409 NPI number — REGENTS UNIV OF CALIF LOS ANGELES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REGENTS UNIV OF CALIF LOS ANGELES
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:
1770882409
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/31/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
757 WESTWOOD PLZ
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90095-1730
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-267-9308
Provider Business Mailing Address Fax Number:
310-267-3516

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 MEDICAL PLZ
Provider Second Line Business Practice Location Address:
SUITE 540
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90095-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-825-8551
Provider Business Practice Location Address Fax Number:
310-206-2331
Provider Enumeration Date:
03/21/2011

Additional Information

Authorized Official

Authorized Official Last Name:
DAVIS
Authorized Official First Name:
RONALD
Authorized Official Middle Name:
ANTHONY
Authorized Official Title or Position:
CFO UCLA HOSPITAL SYSTEM
Authorized Official Telephone Number:
310-794-8627

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  930000165 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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