Provider Demographics
NPI:1831497270
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:CHIEF FINANCIAL OFFICER
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 1:757 WESTWOOD PLZ
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-1730
Mailing Address - Country:US
Mailing Address - Phone:310-267-9308
Mailing Address - Fax:310-267-3516
Practice Address - Street 1:1000 VETERAN AVE
Practice Address - Street 2:A -744
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-2704
Practice Address - Country:US
Practice Address - Phone:310-794-1323
Practice Address - Fax:310-794-1457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-09
Last Update Date:2013-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA930000165332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0493820008Medicare NSC
CA05-0262Medicare PIN