Provider Demographics
NPI:1528224029
Name:HARBOR UCLA MEDICAL CENTER
Entity Type:Organization
Organization Name:HARBOR UCLA MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSING STUDENT
Authorized Official - Prefix:
Authorized Official - First Name:CLARISSA
Authorized Official - Middle Name:MAGNO
Authorized Official - Last Name:CABALLERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-940-8374
Mailing Address - Street 1:4012 W 129TH ST
Mailing Address - Street 2:APT. #3
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-5245
Mailing Address - Country:US
Mailing Address - Phone:310-644-3564
Mailing Address - Fax:
Practice Address - Street 1:4012 W 129TH ST
Practice Address - Street 2:APT. #3
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-5245
Practice Address - Country:US
Practice Address - Phone:310-644-3564
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-04
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty