1831497270 NPI number — REGENTS UNIV OF CALIF LOS ANGELES

Table of content: MIRABEL MANKA (NPI 1710563051)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831497270 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:
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:
1831497270
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/16/2024
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:
1000 VETERAN AVE
Provider Second Line Business Practice Location Address:
A -744
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90024-2704
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-794-1323
Provider Business Practice Location Address Fax Number:
310-794-1457
Provider Enumeration Date:
03/09/2011

Additional Information

Authorized Official

Authorized Official Last Name:
WALLACE
Authorized Official First Name:
TAMMY
Authorized Official Middle Name:
LEHR
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
310-267-9307

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)





Copyright © 2007-2025 www.npivalidator.com