Provider Demographics
NPI:1437117074
Name:THE REGENTS OF THE UNIVERSITY OF CALIFORNIA
Entity Type:Organization
Organization Name:THE REGENTS OF THE UNIVERSITY OF CALIFORNIA
Other - Org Name:UCLA NEUROLOGY GROUP PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROFESSOR OF CLINICAL NEURO
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:
Authorized Official - Last Name:NUWER
Authorized Official - Suffix:
Authorized Official - Credentials:MD PHD
Authorized Official - Phone:310-794-1195
Mailing Address - Street 1:FILE 2939
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-2939
Mailing Address - Country:US
Mailing Address - Phone:310-301-8709
Mailing Address - Fax:301-301-8751
Practice Address - Street 1:300 UCLA MEDICAL PLZ
Practice Address - Street 2:SUITE B200
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-8346
Practice Address - Country:US
Practice Address - Phone:310-799-6596
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0056050Medicaid
CAHW12002AMedicare PIN
CAHW12002Medicare PIN