Provider Demographics
NPI:1770882409
Name:REGENTS UNIV OF CALIF LOS ANGELES
Entity type:Organization
Organization Name:REGENTS UNIV OF CALIF LOS ANGELES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO UCLA HOSPITAL SYSTEM
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:LEHR
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-267-9307
Mailing Address - Street 1:757 WESTWOOD PLZ
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-1730
Mailing Address - Country:US
Mailing Address - Phone:310-267-9308
Mailing Address - Fax:310-267-3516
Practice Address - Street 1:200 MEDICAL PLZ
Practice Address - Street 2:SUITE 540
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-0001
Practice Address - Country:US
Practice Address - Phone:310-825-8551
Practice Address - Fax:310-206-2331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-21
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA930000165332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05-0262Medicare PIN
CA0493820001Medicare NSC