Provider Demographics
NPI: | 1760531198 |
---|---|
Name: | UNIVERSITY HEALTHCARE ALLIANCE |
Entity Type: | Organization |
Organization Name: | UNIVERSITY HEALTHCARE ALLIANCE |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | DIRECTOR REIMBURSEMENT |
Authorized Official - Prefix: | MS |
Authorized Official - First Name: | KRISTINE |
Authorized Official - Middle Name: | M |
Authorized Official - Last Name: | RUSLEN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 510-974-8297 |
Mailing Address - Street 1: | PO BOX 742244 |
Mailing Address - Street 2: | |
Mailing Address - City: | LOS ANGELES |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 90074-2244 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 888-924-1036 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 14777 LOS GATOS BLVD FL 2 |
Practice Address - Street 2: | |
Practice Address - City: | LOS GATOS |
Practice Address - State: | CA |
Practice Address - Zip Code: | 95032-2059 |
Practice Address - Country: | US |
Practice Address - Phone: | 888-924-1036 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-01-08 |
Last Update Date: | 2020-06-23 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Single Specialty | |
No | 207K00000X | Allopathic & Osteopathic Physicians | Allergy & Immunology | Group - Single Specialty | |
No | 207N00000X | Allopathic & Osteopathic Physicians | Dermatology | Group - Single Specialty | |
No | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Single Specialty |
No | 207RE0101X | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism | Group - Single Specialty |
No | 207RG0100X | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | Group - Single Specialty |
No | 207RH0003X | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | Group - Single Specialty |
No | 207RR0500X | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology | Group - Single Specialty |
No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Single Specialty | |
No | 207W00000X | Allopathic & Osteopathic Physicians | Ophthalmology | Group - Single Specialty | |
No | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Single Specialty | |
No | 207Y00000X | Allopathic & Osteopathic Physicians | Otolaryngology | Group - Single Specialty | |
No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Single Specialty | |
No | 213E00000X | Podiatric Medicine & Surgery Service Providers | Podiatrist | Group - Single Specialty | |
No | 363LX0001X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Obstetrics & Gynecology | Group - Single Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
CA | CA111840 | Medicare UPIN | |
CA | MMM00087M | Medicare UPIN | |
CA | CA111839 | Medicare UPIN |