Provider Demographics
NPI:1194014613
Name:THE REGENTS OF THE UNIVERSITY OF CALIFORNIA
Entity Type:Organization
Organization Name:THE REGENTS OF THE UNIVERSITY OF CALIFORNIA
Other - Org Name:SANTA MONICA-UCLA MEDICAL CENTER AND ORTHOPAEDIC HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:ALVIN
Authorized Official - Last Name:STATON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-267-9308
Mailing Address - Street 1:1250 16TH ST
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-1249
Mailing Address - Country:US
Mailing Address - Phone:310-319-4338
Mailing Address - Fax:310-319-4821
Practice Address - Street 1:1250 16TH ST
Practice Address - Street 2:1 FLOOR EMERGENCY DEPARTMENT
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-1249
Practice Address - Country:US
Practice Address - Phone:310-319-4338
Practice Address - Fax:310-319-4821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-05
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA930000146332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05-0112Medicare PIN