Provider Demographics
NPI: | 1710287297 |
---|---|
Name: | REGENTS UNIVERSITY OF CALIFORNIA |
Entity Type: | Organization |
Organization Name: | REGENTS UNIVERSITY OF CALIFORNIA |
Other - Org Name: | UCLA CPN SANTA MONICA BAY PHYSICIANS |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | DIRECTOR OF ACCOUNTING |
Authorized Official - Prefix: | |
Authorized Official - First Name: | KATHERINE |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | HALE |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 310-301-5311 |
Mailing Address - Street 1: | 5767 W CENTURY BLVD |
Mailing Address - Street 2: | SUITE 400 |
Mailing Address - City: | LOS ANGELES |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 90045-5631 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 310-459-2363 |
Mailing Address - Fax: | 310-459-1517 |
Practice Address - Street 1: | 2001 SANTA MONICA BLVD STE 860W |
Practice Address - Street 2: | |
Practice Address - City: | SANTA MONICA |
Practice Address - State: | CA |
Practice Address - Zip Code: | 90404-2189 |
Practice Address - Country: | US |
Practice Address - Phone: | 310-828-3209 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2010-10-29 |
Last Update Date: | 2021-04-30 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CA | 207N00000X, 207Q00000X, 207QA0000X, 207QG0300X, 207QS0010X, 207R00000X, 207RC0000X, 207RC0001X, 207RC0200X, 207RI0200X, 207RP1001X, 2084N0400X, 208600000X, 261QM1300X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
No | 207N00000X | Allopathic & Osteopathic Physicians | Dermatology | Group - Multi-Specialty | |
No | 207QA0000X | Allopathic & Osteopathic Physicians | Family Medicine | Adolescent Medicine | Group - Multi-Specialty |
No | 207QG0300X | Allopathic & Osteopathic Physicians | Family Medicine | Geriatric Medicine | Group - Multi-Specialty |
No | 207QS0010X | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine | Group - Multi-Specialty |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
No | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Multi-Specialty |
No | 207RC0001X | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical Cardiac Electrophysiology | Group - Multi-Specialty |
No | 207RC0200X | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | Group - Multi-Specialty |
No | 207RI0200X | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease | Group - Multi-Specialty |
No | 207RP1001X | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | Group - Multi-Specialty |
No | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | Group - Multi-Specialty |
No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
No | 261QM1300X | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
CA | EO264A | Medicare PIN |