Provider Demographics
NPI:1710087762
Name:REGENTS OF THE UNIV OF CA
Entity Type:Organization
Organization Name:REGENTS OF THE UNIV OF CA
Other - Org Name:UCLA MED CTR CHS OUTPATIENT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DRTR/PHCY SVCS
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:ZALBA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:310-267-8500
Mailing Address - Street 1:300 STEIN PLZ RM 123
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-7187
Mailing Address - Country:US
Mailing Address - Phone:310-267-3027
Mailing Address - Fax:310-267-2498
Practice Address - Street 1:300 STEIN PLZ RM 123
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-0001
Practice Address - Country:US
Practice Address - Phone:310-267-3027
Practice Address - Fax:310-267-2498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X
CAPHE409733336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1710087762Medicaid
1999568OtherPK