Provider Demographics
NPI:1164808986
Name:UCLA FAMILY MEDICINE RESIDENCY PROGRAM
Entity Type:Organization
Organization Name:UCLA FAMILY MEDICINE RESIDENCY PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HABAKUK
Authorized Official - Middle Name:
Authorized Official - Last Name:MICHEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-319-4700
Mailing Address - Street 1:1920 COLORADO AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404
Mailing Address - Country:US
Mailing Address - Phone:310-319-4700
Mailing Address - Fax:
Practice Address - Street 1:1920 COLORADO AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404
Practice Address - Country:US
Practice Address - Phone:310-319-4700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-04
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care