Provider Demographics
NPI:1356614291
Name:REGENTS UNIV OF CALIF LOS ANGELES
Entity type:Organization
Organization Name:REGENTS UNIV OF CALIF LOS ANGELES
Other - Org Name:<UNAVAIL>
Other - Org Type:
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 1:10833 LE CONTE AVE
Practice Address - Street 2:BE-144
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-1730
Practice Address - Country:US
Practice Address - Phone:310-267-5337
Practice Address - Fax:310-267-1062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-22
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05-0262Medicare PIN