Provider Demographics
NPI:1033243753
Name:ARTHUR ASHE STUDENT HEALTH AND WELLNESS CENTER
Entity Type:Organization
Organization Name:ARTHUR ASHE STUDENT HEALTH AND WELLNESS CENTER
Other - Org Name:UCLA STUDENT HEALTH
Other - Org Type:Other Name
Authorized Official - Title/Position:HIIPA COORDINATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-206-6356
Mailing Address - Street 1:BOX 951703
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-1703
Mailing Address - Country:US
Mailing Address - Phone:310-794-7283
Mailing Address - Fax:310-267-1996
Practice Address - Street 1:221 WEST WOOD PLAZA
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-1703
Practice Address - Country:US
Practice Address - Phone:310-794-7283
Practice Address - Fax:310-267-1996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA380579261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health