Provider Demographics
NPI:1780818765
Name:REGENTS UNIV OF CALIF LOS ANGELES
Entity Type:Organization
Organization Name:REGENTS UNIV OF CALIF LOS ANGELES
Other - Org Name:RONALD REAGAN UCLAMC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:ALVIN
Authorized Official - Last Name:STATON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-267-9308
Mailing Address - Street 1:10920 WILSHIRE BLVD STE 1700
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-6542
Mailing Address - Country:US
Mailing Address - Phone:310-794-6129
Mailing Address - Fax:310-794-8399
Practice Address - Street 1:200 UCLA MEDICAL PLZ
Practice Address - Street 2:SUITE135
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-8344
Practice Address - Country:US
Practice Address - Phone:310-267-9308
Practice Address - Fax:310-267-3516
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REGENTS OF THE UNIVERSITY OF CALIFORNIA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-05-06
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40977332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0493820003Medicare NSC