1982738068 NPI number — UNIVERSITY OF SOUTHERN CALIFORNIA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982738068 NPI number — UNIVERSITY OF SOUTHERN CALIFORNIA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSITY OF SOUTHERN 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:
1982738068
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/20/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 513199
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:
90051-1199
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-442-2976
Provider Business Mailing Address Fax Number:
323-442-2982

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2250 ALCAZAR STREET
Provider Second Line Business Practice Location Address:
CSC 107 109
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90033
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-442-2976
Provider Business Practice Location Address Fax Number:
323-442-2982
Provider Enumeration Date:
03/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DICKEY
Authorized Official First Name:
TODD
Authorized Official Middle Name:
Authorized Official Title or Position:
SR VP ADMINISTRATION
Authorized Official Telephone Number:
213-740-8184

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  05D0642462 , 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)

  • Identifier: 05D0642462 . This is a "CLIA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: CLF2696 . This is a "STATE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 690000015 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZZ59171Z , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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