Provider Demographics
NPI:1740583988
Name:UNIVERSITY OF CALIFORNIA AT LOS ANGELES
Entity type:Organization
Organization Name:UNIVERSITY OF CALIFORNIA AT LOS ANGELES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL INSTRUCTOR/ RESEARCH ASSOC
Authorized Official - Prefix:MS
Authorized Official - First Name:NU
Authorized Official - Middle Name:T
Authorized Official - Last Name:LU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-794-6253
Mailing Address - Street 1:700 TIVERTON AVE BLDG 8-240
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-8361
Mailing Address - Country:US
Mailing Address - Phone:310-794-6253
Mailing Address - Fax:310-206-5553
Practice Address - Street 1:10945 LECONTE AVE STE 2333
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-0001
Practice Address - Country:US
Practice Address - Phone:310-794-6253
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-09
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA99720282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital