Provider Demographics
NPI:1679978514
Name:UNIVERSITY OF SOUTHERN CALIFORNIA
Entity Type:Organization
Organization Name:UNIVERSITY OF SOUTHERN CALIFORNIA
Other - Org Name:USC TELEHEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MS
Authorized Official - First Name:MARYANN
Authorized Official - Middle Name:
Authorized Official - Last Name:FRATTAROLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-821-5928
Mailing Address - Street 1:1150 S OLIVE ST
Mailing Address - Street 2:SUITE T-320
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90015-2211
Mailing Address - Country:US
Mailing Address - Phone:213-821-5928
Mailing Address - Fax:213-740-8080
Practice Address - Street 1:1150 S OLIVE ST
Practice Address - Street 2:SUITE T-320
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-2211
Practice Address - Country:US
Practice Address - Phone:213-821-5928
Practice Address - Fax:213-740-8080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-04
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health