Provider Demographics
NPI:1336534908
Name:HARBOR UCLA MEDICAL CENTER
Entity Type:Organization
Organization Name:HARBOR UCLA MEDICAL CENTER
Other - Org Name:HARBOR UCLA MEDICAL CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:NP
Authorized Official - Prefix:
Authorized Official - First Name:EVANGELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:OJALES
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:818-693-4458
Mailing Address - Street 1:1000 W CARSON ST
Mailing Address - Street 2:OPHTHALMOLOGY CLINIC BOX 6
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90810-1408
Mailing Address - Country:US
Mailing Address - Phone:310-222-2735
Mailing Address - Fax:
Practice Address - Street 1:1000 W CARSON ST
Practice Address - Street 2:OPHTHALMOLOGY CLINIC BOX 6
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90810-1408
Practice Address - Country:US
Practice Address - Phone:310-222-2735
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-01
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA363LXF0000X261QS0132X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery