Provider Demographics
NPI:1508924945
Name:OLIVE VIEW UCLA MEDICAL CENTER
Entity Type:Organization
Organization Name:OLIVE VIEW UCLA MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF, DEPARTMENT OF ANESTHESIOLOG
Authorized Official - Prefix:DR
Authorized Official - First Name:RIMA
Authorized Official - Middle Name:
Authorized Official - Last Name:MATEVOSIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-364-4350
Mailing Address - Street 1:10125 BROMONT AVE
Mailing Address - Street 2:
Mailing Address - City:SUN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91352-1147
Mailing Address - Country:US
Mailing Address - Phone:818-252-5686
Mailing Address - Fax:818-252-7187
Practice Address - Street 1:10125 BROMONT AVE
Practice Address - Street 2:
Practice Address - City:SUN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91352-1147
Practice Address - Country:US
Practice Address - Phone:818-252-5686
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA69455251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH50633Medicare UPIN