Provider Demographics
NPI:1104004308
Name:UCLA MED CTR PHARMACEUTICAL TECHNOLOGY
Entity Type:Organization
Organization Name:UCLA MED CTR PHARMACEUTICAL TECHNOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, PHARMACEUTICAL SERVICES
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:ZALBA
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:310-825-7101
Mailing Address - Street 1:1010 VETERAN AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-0001
Mailing Address - Country:US
Mailing Address - Phone:310-825-5057
Mailing Address - Fax:
Practice Address - Street 1:1010 VETERAN AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-0001
Practice Address - Country:US
Practice Address - Phone:310-825-5057
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RONALD REAGAN UCLA MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHE455793336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHE45579OtherSTATE LICENSE NUMBER
CAPHE45579OtherSTATE LICENSE NUMBER