Provider Demographics
NPI: | 1982667663 |
---|---|
Name: | UC REGENTS |
Entity Type: | Organization |
Organization Name: | UC REGENTS |
Other - Org Name: | UCLA DEPT OF PEDIATRIC GRP PRACTICE |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | INTERIM EXECUTIVE CHAIR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | SHERIN |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | DEVASKAR |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 370-825-5095 |
Mailing Address - Street 1: | 10833 LE CONTE AVE |
Mailing Address - Street 2: | 32-263 CHS |
Mailing Address - City: | LOS ANGELES |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 90095-3075 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 310-206-3952 |
Mailing Address - Fax: | 310-206-0209 |
Practice Address - Street 1: | 200 UCLA MEDICAL PLAZA |
Practice Address - Street 2: | SUITE 265 |
Practice Address - City: | LOS ANGELES |
Practice Address - State: | CA |
Practice Address - Zip Code: | 90095-8344 |
Practice Address - Country: | US |
Practice Address - Phone: | 310-825-0867 |
Practice Address - Fax: | 310-206-5146 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-04-11 |
Last Update Date: | 2014-11-18 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
No | 2080N0001X | Allopathic & Osteopathic Physicians | Pediatrics | Neonatal-Perinatal Medicine | Group - Multi-Specialty |
No | 2080P0006X | Allopathic & Osteopathic Physicians | Pediatrics | Developmental - Behavioral Pediatrics | Group - Multi-Specialty |
No | 2080P0201X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Allergy/Immunology | Group - Multi-Specialty |
No | 2080P0202X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Cardiology | Group - Multi-Specialty |
No | 2080P0203X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Critical Care Medicine | Group - Multi-Specialty |
No | 2080P0204X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Emergency Medicine | Group - Multi-Specialty |
No | 2080P0205X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Endocrinology | Group - Multi-Specialty |
No | 2080P0206X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Gastroenterology | Group - Multi-Specialty |
No | 2080P0207X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Hematology-Oncology | Group - Multi-Specialty |
No | 2080P0208X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Infectious Diseases | Group - Multi-Specialty |
No | 2080P0210X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Nephrology | Group - Multi-Specialty |
No | 2080P0214X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Pulmonology | Group - Multi-Specialty |
No | 2080P0216X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Rheumatology | Group - Multi-Specialty |
No | 2080S0010X | Allopathic & Osteopathic Physicians | Pediatrics | Sports Medicine | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
CA | W11810 | Medicare ID - Type Unspecified |