Provider Demographics
NPI:1659961720
Name:REGENTS OF THE UNIVERSITY OF CALIFORNIA UCLA ASHE CENTER
Entity Type:Organization
Organization Name:REGENTS OF THE UNIVERSITY OF CALIFORNIA UCLA ASHE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO/ CO-EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:BOLLARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-206-9855
Mailing Address - Street 1:221 WESTWOOD PLAZA
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-1703
Mailing Address - Country:US
Mailing Address - Phone:310-206-6216
Mailing Address - Fax:
Practice Address - Street 1:221 WESTWOOD PLAZA
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-1703
Practice Address - Country:US
Practice Address - Phone:310-825-4073
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-22
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health