Provider Demographics
NPI:1811390040
Name:UCLA RONALD REAGAN HOSPITAL
Entity Type:Organization
Organization Name:UCLA RONALD REAGAN HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP II
Authorized Official - Prefix:
Authorized Official - First Name:NORMA
Authorized Official - Middle Name:
Authorized Official - Last Name:TIEDGE
Authorized Official - Suffix:II
Authorized Official - Credentials:NP
Authorized Official - Phone:310-267-7610
Mailing Address - Street 1:757 WESTWOOD PLAZA
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095
Mailing Address - Country:US
Mailing Address - Phone:310-267-7610
Mailing Address - Fax:
Practice Address - Street 1:12302 WILLOW SPRING DR
Practice Address - Street 2:
Practice Address - City:MOORPARK
Practice Address - State:CA
Practice Address - Zip Code:93021-2780
Practice Address - Country:US
Practice Address - Phone:310-267-7610
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-02
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95001281282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital