Provider Demographics
NPI:1164764809
Name:UCLA
Entity Type:Organization
Organization Name:UCLA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MSO
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEW-KARON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-206-6741
Mailing Address - Street 1:700 TIVERTON AVE
Mailing Address - Street 2:7-155 FACTOR, BOX 951689
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-1689
Mailing Address - Country:US
Mailing Address - Phone:310-206-6741
Mailing Address - Fax:310-825-6309
Practice Address - Street 1:700 TIVERTON AVE
Practice Address - Street 2:7-155 FACTOR, BOX 951689
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-1689
Practice Address - Country:US
Practice Address - Phone:310-206-6741
Practice Address - Fax:310-825-6309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-20
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital