Provider Demographics
NPI:1720595564
Name:UNIVERSITY HEALTHCARE ALLIANCE
Entity Type:Organization
Organization Name:UNIVERSITY HEALTHCARE ALLIANCE
Other - Org Name:CCMG
Other - Org Type:Other Name
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:510-974-8258
Mailing Address - Fax:510-974-8322
Practice Address - Street 1:388 9TH ST STE 250
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-4294
Practice Address - Country:US
Practice Address - Phone:510-571-0133
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-02
Last Update Date:2018-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty