Provider Demographics
NPI:1720493323
Name:UNIVERSITY HEALTHCARE ALLIANCE
Entity Type:Organization
Organization Name:UNIVERSITY HEALTHCARE ALLIANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF REIMBURSEMENT
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-974-8297
Mailing Address - Street 1:PO BOX 742244
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-2244
Mailing Address - Country:US
Mailing Address - Phone:888-924-1036
Mailing Address - Fax:
Practice Address - Street 1:3100 TELEGRAPH AVE STE 2102
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3210
Practice Address - Country:US
Practice Address - Phone:510-286-8160
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-23
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1760531198OtherNPI