Provider Demographics
NPI:1740359728
Name:HARBOR UCLA MEDICAL CENTER
Entity type:Organization
Organization Name:HARBOR UCLA MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MHN.RN
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:GURROLA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:310-222-5072
Mailing Address - Street 1:1456 RONAN AVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:CA
Mailing Address - Zip Code:90744-2022
Mailing Address - Country:US
Mailing Address - Phone:310-834-7301
Mailing Address - Fax:
Practice Address - Street 1:1456 RONAN AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:CA
Practice Address - Zip Code:90744-2022
Practice Address - Country:US
Practice Address - Phone:310-834-7301
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA269203283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital