1215381843 NPI number — THE REGENTS OF THE UNIVERSITY OF CALIFORNIA

Table of content: JESTINE TERYSSA MACDONALD MD (NPI 1033777503)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215381843 NPI number — THE REGENTS OF THE UNIVERSITY OF CALIFORNIA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE REGENTS OF THE UNIVERSITY OF CALIFORNIA
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:
6
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:
1215381843
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/31/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5767 W CENTURY BLVD
Provider Second Line Business Mailing Address:
SUITE 400
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90045-5631
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-301-8714
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7320 WOODLAKE AVE
Provider Second Line Business Practice Location Address:
STE. 320
Provider Business Practice Location Address City Name:
WEST HILLS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91307-1468
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-436-7686
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/20/2016

Additional Information

Authorized Official

Authorized Official Last Name:
HALE
Authorized Official First Name:
KATHERINE
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF ACCOUNTING
Authorized Official Telephone Number:
310-301-5311

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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