Provider Demographics
NPI:1952308363
Name:REGENTS UNIV OF CALIF LOS ANGELES
Entity Type:Organization
Organization Name:REGENTS UNIV OF CALIF LOS ANGELES
Other - Org Name:RESNICK NEUROPSYCHIATRIC HOSPITAL AT UCLA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:LEHR
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-267-9307
Mailing Address - Street 1:10920 WILSHIRE BLVD
Mailing Address - Street 2:STE 1700
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-6502
Mailing Address - Country:US
Mailing Address - Phone:310-948-7371
Mailing Address - Fax:
Practice Address - Street 1:150 UCLA MEDICAL PLAZA
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-0001
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:THE REGENTS OF THE UNIVERSITY OF CALIFORNIA LOS ANGELES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-06-30
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA930000204283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHSM34009FMedicaid
CA05-4009Medicare Oscar/Certification