Provider Demographics
NPI:1326249962
Name:UCLA
Entity Type:Organization
Organization Name:UCLA
Other - Org Name:OLYMPIA MEDICAL CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TAMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:BARUCH-OREN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-932-5346
Mailing Address - Street 1:5420 SYLMAR AVE APT 208
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91401-5142
Mailing Address - Country:US
Mailing Address - Phone:818-908-1097
Mailing Address - Fax:
Practice Address - Street 1:5900 W OLYMPIC BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-4671
Practice Address - Country:US
Practice Address - Phone:323-932-5342
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA70968282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital