Provider Demographics
NPI:1942412747
Name:REGENTS OF UNIVERSITY OF CALIFORNIA AT LOS ANGELES
Entity Type:Organization
Organization Name:REGENTS OF UNIVERSITY OF CALIFORNIA AT LOS ANGELES
Other - Org Name:UCLA PERINATAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:MR
Authorized Official - First Name:KHALIL
Authorized Official - Middle Name:MA
Authorized Official - Last Name:TABSH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-882-2441
Mailing Address - Street 1:8767 BAIRD AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-4006
Mailing Address - Country:US
Mailing Address - Phone:818-882-2441
Mailing Address - Fax:818-882-2466
Practice Address - Street 1:10833 LE CONTE AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024
Practice Address - Country:US
Practice Address - Phone:310-208-4558
Practice Address - Fax:310-267-0265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC37937174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0085230Medicaid