Provider Demographics
NPI:1417137589
Name:REGENTS UNIVERSITY OF CALIFORNIA LOS ANGELES
Entity Type:Organization
Organization Name:REGENTS UNIVERSITY OF CALIFORNIA LOS ANGELES
Other - Org Name:UCLA IMMUNOGENETICS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:805-267-4570
Mailing Address - Street 1:1000 VETERAN AVE
Mailing Address - Street 2:SUITE 1-520
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-1652
Mailing Address - Country:US
Mailing Address - Phone:310-206-0258
Mailing Address - Fax:
Practice Address - Street 1:1000 VETERAN AVE
Practice Address - Street 2:SUITE 1-520
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-0001
Practice Address - Country:US
Practice Address - Phone:310-206-0258
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-06
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACLF2743291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
05-HL03Medicare PIN