1861869042 NPI number — UC REGENTS PHARMACOLOGY AND NUCLEAR MEDICINE PRACTICE GROUP

Table of content: (NPI 1861869042)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861869042 NPI number — UC REGENTS PHARMACOLOGY AND NUCLEAR MEDICINE PRACTICE GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UC REGENTS PHARMACOLOGY AND NUCLEAR MEDICINE PRACTICE 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:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
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Provider Other Credential Text:
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NPI Number Information

NPI Number:
1861869042
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/24/2015
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:
310-794-9513
Provider Business Mailing Address Fax Number:
310-267-2538

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10833 LE CONTE AVE
Provider Second Line Business Practice Location Address:
AR105 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:
90095-3075
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-794-9513
Provider Business Practice Location Address Fax Number:
310-267-2538
Provider Enumeration Date:
08/24/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MOSESSIAN
Authorized Official First Name:
SHERLY
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF ADMINITRATIVE OFFICER
Authorized Official Telephone Number:
310-267-1188

Provider Taxonomy Codes

  • Taxonomy code: 207U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2085N0904X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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