1497732630 NPI number — UCLA PATHOLOGY AND LABORATORY MEDICINE GROUP

Table of content: (NPI 1497732630)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497732630 NPI number — UCLA PATHOLOGY AND LABORATORY MEDICINE GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UCLA PATHOLOGY AND LABORATORY MEDICINE GROUP
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:
UC REGENTS UCLA PATHOLOGY & LAB MED GRP
Provider Other Organization Name Type Code:
3
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:
1497732630
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/06/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
FILE 55632
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:
90074
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-794-7953
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10833 LE CONTE AVENUE
Provider Second Line Business Practice Location Address:
SUITE B-186 CHS
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-794-7953
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/29/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BINDER
Authorized Official First Name:
SCOTT
Authorized Official Middle Name:
Authorized Official Title or Position:
PROFESSOR & SR VICE CHAIR
Authorized Official Telephone Number:
310-794-7953

Provider Taxonomy Codes

  • Taxonomy code: 207ZI0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ZM0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ZN0500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ZP0007X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ZP0101X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ZP0102X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207ZP0104X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: GR0083761 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: GR0083760 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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