Provider Demographics
NPI:1821056458
Name:UCLA ASSOCIATED GENERAL SURGEONS
Entity Type:Organization
Organization Name:UCLA ASSOCIATED GENERAL SURGEONS
Other - Org Name:ASSOCIATED GENERAL SURGEONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORRISSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-825-5318
Mailing Address - Street 1:5767 W CENTURY BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-5632
Mailing Address - Country:US
Mailing Address - Phone:310-301-8709
Mailing Address - Fax:310-301-8751
Practice Address - Street 1:1245 16TH STREET
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-1235
Practice Address - Country:US
Practice Address - Phone:310-206-1187
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW1864BMedicare ID - Type Unspecified