Provider Demographics
NPI:1225364797
Name:UCLA
Entity Type:Organization
Organization Name:UCLA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESEARCH COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ROSEANNA
Authorized Official - Middle Name:PAULINE
Authorized Official - Last Name:MALONE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:310-794-0242
Mailing Address - Street 1:842 PALMS BLVD
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:CA
Mailing Address - Zip Code:90291-3851
Mailing Address - Country:US
Mailing Address - Phone:310-794-0242
Mailing Address - Fax:310-794-0244
Practice Address - Street 1:924 WESTWOOD BLVD STE 200
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-2923
Practice Address - Country:US
Practice Address - Phone:310-794-0242
Practice Address - Fax:310-794-0244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-19
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18439282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital