Provider Demographics
NPI:1639898414
Name:REGENTS UNIV OF CALIF LOS ANGELES
Entity Type:Organization
Organization Name:REGENTS UNIV OF CALIF LOS ANGELES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO UCLA HOSPITAL SYSTEM
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-794-8627
Mailing Address - Street 1:757 WESTWOOD PLZ RM B504E
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-7423
Mailing Address - Country:US
Mailing Address - Phone:310-794-1176
Mailing Address - Fax:
Practice Address - Street 1:200 UCLA MEDICAL PLZ STE 135
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-8344
Practice Address - Country:US
Practice Address - Phone:310-794-1176
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy