Provider Demographics
NPI:1770728982
Name:THE REGENTS OF THE UNIVERSITY OF CALIFORNIA AT LOS ANGELES
Entity type:Organization
Organization Name:THE REGENTS OF THE UNIVERSITY OF CALIFORNIA AT LOS ANGELES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
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:310-267-9307
Mailing Address - Street 1:10920 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 1700
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-6502
Mailing Address - Country:US
Mailing Address - Phone:310-794-6129
Mailing Address - Fax:310-794-8399
Practice Address - Street 1:757 WESTWOOD PLZ
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-8358
Practice Address - Country:US
Practice Address - Phone:310-267-9308
Practice Address - Fax:310-267-3516
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE REGENTS OF THE UNIVERSITY OF CALIFORNIA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-12-03
Last Update Date:2009-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA930000165282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0493820003OtherDURABLE MEDICAL EQUIPMENT AND MEDICAL SUPPLIES-PARENTERAL & ENTERAL NUTRITION
CAZZT30262FMedicaid
CAHSC30262FMedicaid