1275591802 NPI number — UC REGENTS

Table of content: (NPI 1275591802)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275591802 NPI number — UC REGENTS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UC REGENTS
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:
UCLA FAMILY HEALTH CENTER
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:
1275591802
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/26/2024
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:
310-301-8713
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1920 COLORADO AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTA MONICA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90404-3414
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-319-4700
Provider Business Practice Location Address Fax Number:
310-301-8751
Provider Enumeration Date:
05/03/2006

Additional Information

Authorized Official

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

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207QA0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207QA0505X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207QG0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207QS0010X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: ZZZP1939Z , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: GR005503G , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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