Provider Demographics
NPI:1609131655
Name:MATTEL CHILDREN'S HOSPITAL
Entity Type:Organization
Organization Name:MATTEL CHILDREN'S HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIR, PEDIATRIC NEPHROLOGY
Authorized Official - Prefix:DR
Authorized Official - First Name:ISIDRO
Authorized Official - Middle Name:
Authorized Official - Last Name:SALUSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-206-6987
Mailing Address - Street 1:MATTEL CHILDRENS HOSPITAL AT UCLA
Mailing Address - Street 2:DAVID GEFFEN SCHOOL OF MEDICINE, BOX 951752
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-1752
Mailing Address - Country:US
Mailing Address - Phone:310-206-6987
Mailing Address - Fax:310-825-0442
Practice Address - Street 1:MATTEL CHILDRENS HOSPITAL AT UCLA
Practice Address - Street 2:DAVID GEFFEN SCHOOL OF MEDICINE, BOX 951752
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-1752
Practice Address - Country:US
Practice Address - Phone:310-206-6987
Practice Address - Fax:310-825-0442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-05
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA118603282NC2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC2000XHospitalsGeneral Acute Care HospitalChildren