Provider Demographics
NPI:1033516943
Name:UC REGENTS
Entity Type:Organization
Organization Name:UC REGENTS
Other - Org Name:UCLA DEPT. OF PEDIATRIC GRP PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE CHAIR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:DEVASKAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-825-5095
Mailing Address - Street 1:10833 LE CONTE AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-1752
Mailing Address - Country:US
Mailing Address - Phone:310-825-5904
Mailing Address - Fax:310-206-8616
Practice Address - Street 1:10833 LE CONTE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-1752
Practice Address - Country:US
Practice Address - Phone:310-825-5904
Practice Address - Fax:310-206-8616
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UC REGENTS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-11-21
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty